Revised 04/2009
UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF TEXAS INSTRUCTIONS FOR SUBMISSION OF AN APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS
If the applicant is an individual, attach a photocopy of your current driver's license. If you do not have a current valid driver's license, other identification which contains a photograph and current address AND a copy of your social security card is required. [The license or other documents provide proof of ownership of unclaimed funds]. SEE PRIVACY NOTE BELOW. If the applicant is a corporation, attach documents which establish the right to payment or, if the applicant is not the original corporate creditor, documents which establish the proper chain of ownership of the claim from the original corporate creditor. For all applicants: 1. Submit a completed Application directly to the Court. See Attachment (1). 2. Attach to the Application a certificate of service evidencing that a copy of the Application has been mailed to the proper office of the United States Attorney for the Eastern District of Texas (as determined by the case number) pursuant to Title 28 U.S.C. §2042. Notice to the United States Attorney is required in ALL instances. See Attachment (2). 3. Attach a proposed Order. See Attachment (3). 4. Attach proof of ownership as described above. This is particularly important when the applicant is different from the payee listed in the Court's records; additional information must be included which proves ownership by the applicant. 5. Mail a copy of the entire application packet to the United States Attorney's Office for the division indicated in the case number. For claimants in multiple cases, a separate Application must be prepared for each case with all the above requirements attached to each Application. All indications of fraud will be promptly forwarded to the United States Attorney for review. committed to the protection of personal identification information. Therefore, it is recommended that an individual applicant's driver's license number contained in the Application be blacked out for privacy considerations. It is also recommended that all but the last four digits of a Social Security number be blackened, for the same privacy reasons.
Privacy Note: Because documents filed with the Court are available through the Internet, the Court is
Revised 04/2009
UNITED STATES BANKUPTCY COURT EASTERN DISTRICT OF TEXAS
Application (1)
IN RE:
______________________________
Debtor
______________________________
Bankruptcy Case Number
APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS Comes now the Claimant identified below to make Application for an Order authorizing payment of unclaimed funds now on deposit in the Treasury of the United States for the benefit of Claimant. Claimant was a creditor/debtor in the above captioned bankruptcy case and has not received payment of these funds which are due and owing to the Claimant. Claimant furtlier states that Claimant is:
NAME OF CLAIMANT: ____________________________________________________________ MAILING ADDRESS: _ CI ____________________________________________________________ ___________________________________________________________ TY:___________________________ STATE:______ ZIP:__________
and that a dividend in the amount of $ which dividend is currently unclaimed and held by the Clerk of Court.
was awarded in this case
Claimant certifies under penalty of perjury that all statements made by Claimant on this Application and any attachments required for this Application are, to the best of Claimant's knowledge, true and correct. Accordingly, Claimant requests the Court to enter an Order authorizing payment of the pro rata dividend due upon this claim.
Date:_____________________
___________________________________ Claimant's Signature
110 Tyler,
Mail to:
United States Bankruptcy Court N. College Avenue, 8th Floor TX 75702
Revised 04/2009
Certificate of Service (2) CERTIFICATE OF SERVICE
In accordance with Title 28 U.S.C. Section 2042, the undersigned hereby certifies that on the date designated below a true copy of this application with all required attachments was mailed to [check one as applicable]: For all cases in Beaumont & Lufkin divisions (five-digit case number beginning with 1 or 9):
Office of the United States Attorney Eastern District of Texas Attn: Unclaimed Funds Requests 350 Magnolia Avenue, Suite 150 Beaumont, TX 77701-2248
For all cases in Marshall & Tyler divisions (five-digit case number beginning with 2 or 6):
Office of the United States Attorney Eastern District of Texas Attn: Unclaimed Funds Requests 110 North College Avenue, Suite 700 Tyler, TX 75702-0204
For all cases in Paris, Sherman, & Texarkana divisions (five-digit case number beginning with 3, 4 or 5):
Office of the United States Attorney Eastern District of Texas Attn: Unclaimed Funds Requests 101 East Park Boulevard, Suite 500 Plano, Texas 75074-8858
Date:_____________________
___________________________________ Claimant's Signature
Revised 04/2009
UNITED STATES BANRUPTCY COURT EASTERN DISTRICT OF TEXAS
Proposed Order (3)
IN RE:
______________________________
Debtor
______________________________
Bankruptcy Case Number
ORDER GRANTING APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS The Court having considered the Application for Payment of Unclaimed Funds filed by: {Insert Claimant Name & Mailing Address} ("Claimant') for payment of a dividend from unclaimed funds in the amount of ${Insert Amount} , and, it appearing to the Court that the Claimant is entitled to receive payment, and, these funds are now on deposit in the Treasury of the United States, and that proper notice of the Application was given to the United States Attorney for the Eastern District of Texas pursuant to Title 28 U.S.C. Section 2Ø2, IT IS THEREFORE ORDERED that the Clerk of the Bankruptcy Court direct the issuance of a draft upon the Treasury of the United States in the amount stated above and payable to the Claimant.
UNITED STATES BANKRUPTCY JUDGE