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Petition For Unclaimed Funds And Order Thereon 391 - Oregon
| Petition For Unclaimed Funds And Order Thereon Form. This is a Oregon form and can be used in Bankruptcy Court Federal . |
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UNITED STATES BANKRUPTCY COURT DISTRICT OF OREGON In re ) ) Case No. _____________________ ) ) PETITION FOR UNCLAIMED Debtor(s) ) FUNDS AND ORDER THEREON I, the undersigned petitioner, under penalty of perjury under the laws o f the United States of America, declare (or certify, verify, or state) that the fol lowing statements and information are true and correct: 1. I am petitioning to receive $_________________, the total of all mon ey deposited with the court by the trustee on the following date(s) ______________________________________________, on behalf of t he debtor or creditor named ____________________________________________________________________, whose SSN/Tax ID# is_____________. 2. [Please check and complete only the ONE applicable subparagraph belo w]: A. I am the creditor/debtor named in point 1; and, if creditor/debtor not an individual, my title is (e.g., owner, partner, etc.) ________________________________________________________________________ ____________________________. B. I am an employee of the creditor/debtor named in point 1 and my title is_ ___________________________________. The creditor/debtor is still legally entitled to the money and I am auth orized by such creditor/debtor to file this petition. C. I am the lawful attorney-in-fact for the creditor/debtor named in point 1 and I am duly authorized by the attached original notorized power of attorney to file this petition. I am aware of all p ertinent state law requirements regarding powers of attorney.The following is the address, phone number, and a brief history of the cred itor/debtor named in point 1 (from filing of the claimto present) which includes, if applicable, identification of any sale o f the company and the new and prior owner(s): ________________________________________________________________________ _____________________________ _____________________________________________________________________________________________________ ______________________________________________________________________________________________ _______ ________________________________________________________________________ _____________________________ D. Subparagraphs A, B & C above do not apply, but I am entitled to payment of such money because [state basis for your claim and provide certified copies of supportive documents (e.g., proof of t he transfer of assets of the business originally entitled to the funds, sale of the company, probate documents to substantiate the r ight to act on behalf of the descendants estate, etc. )]: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ ________________________________________________________________________ _____________________________ _____________________________________________________________________________________________________ 3. I have no knowledge that any other party may be entitled to, and am not aware of any dispute regarding, the funds at issue. 4. Enclosed is a photocopy of photo identification (e.g., drivers license or passport) of the Petitioner named below.. I understand that, pursuant to 18 U.S.C. 152, I will be fined not more than $5,000, or imprisoned not more than five years,5 or both, if I have knowingly and fraudulently made any false statements in this document. 6. On ______________ I mailed BOTH: (a) the ORIGINAL of this document (fully completed) to the PORTLAND office of the Clerk, U.S. Bankruptcy Court, 1001 SW 5th Ave, #700, Portland OR 97204; AND (b) a copy to the U.S. Attorney, 1000 SW 3rd Ave. #600, Portland, OR 97204, per 28 U.S.C. 2042. 7. I CERTIFY this document FULLY complies with LBR 1001-1.F. (i.e., it is identical to this courts L ocal Bankruptcy Form). Date executed by petitioner ______________ _________________________________________________________ Petitioners Signature (OSB# if attorney) _________________________________________________________ Petitioners Name (Type or Print) Telephone Number APPROVED AS TO FORM: _________________________________________________________ Petitioners Address _________________________________ _________________________________________________________ Financial Administrator IT IS SO ORDERED: _________________________________________________________ Bankruptcy Judge 391 (1/29/03)
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