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Application For Disbursement Of Unclaimed Funds - Georgia
| Application For Disbursement Of Unclaimed Funds Form. This is a Georgia form and can be used in Southern District Bankruptcy Court Federal . |
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United States Bankruptcy Court Southern District of Georgia In re: Debtor Case Number: Chapter: Application for Disbursement of Unclaimed Funds Pursuant to 28 U.S.C. ยง 2042, I, (Petitioner) state that on (Date) , the following claimant/owner: (Claimant's Name) (Claimant's Social Security # or Tax ID#) (Claimant's Address) (Claimant's Phone #) as a distribution in the above-entitled case and now appears on the became entitled to receive $ records of this Court as the owner of said funds. The amount requested is being held in the Treasury of the United States as unclaimed funds. Petitioner represents that he/she is entitled to receive the requested funds based upon (check the box(es) that apply): Petitioner is the owner of said funds and appears as the owner on the records of the Court; Petitioner is the assignee of the owner's claim to said funds, as evidenced in the attached Affidavit or Assignment of Right; Petitioner is the owner's successor in interest, as evidenced in the attached Affidavit and other identifying documentation; Petitioner is the personal representative of the owner's estate, as evidenced in the attached Affidavit and other identifying documents; , Petitioner is named in a Power of Attorney by grantor, valid under the laws of the State of Georgia, that empowers petitioner to collect the unclaimed funds described above on behalf of the grantor: ( ( ) as the owner of the claim ) as the owner's attorney with authorization to receive said funds American LegalNet, Inc. www.FormsWorkflow.com ( ( ( ) as the assignee of the owner's claim to said funds ) as the owner's successor in interest or ) as the personal representative of the owner's estate This application is submitted with the necessary documents to prove petitioner's identity and status, and the owner's claim of entitlement pursuant to the Court's requirements. (Documents may include power of attorney, formal assignment, letter of appointment, court order, etc.) Petitioner declares under penalty of perjury that sufficient inquiry has been made to satisfy the Court that the above funds have not been previously paid; no other applications for return of said funds are pending; and no party other than claimant/owner is entitled to submit a request for disbursement of the funds. Petitioner certifies that a copy of this application and all attachments was provided to the Office of the U.S. Attorney, . Southern District of Georgia, 100 Bull Street, Savannah, Georgia, 31401, on (Date) Petitioner requests that the Court enter an Order directing payment of the unclaimed funds described above to the petitioner, or if the petitioner is not the owner, to the petitioner on behalf of the owner, in accordance with the documents submitted in support of the application. Name of Petitioner Signature of Petitioner Address of Petitioner Telephone # of Petitioner Revised: February 8, 2006 American LegalNet, Inc. www.FormsWorkflow.com
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