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Statement Of Social Security Or Employee Identification Number (Unclaimed Funds) - Illinois
| Statement Of Social Security Or Employee Identification Number (Unclaimed Funds) Form. This is a Illinois form and can be used in USBC Northern Federal . |
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United States Bankruptcy Court Northern District of Illinois Eastern Division In Re: ) ) ) ) ) Bankruptcy Case No. Debtor Statement of Social Security or Employee Identification Number Name of claimant: Claimant's Social Security or EI Number: ______________________________ ______________________________ I declare under penalty of perjury that the foregoing is true and correct. ______________________________ Signature of Claimant Date ______________________________________________________________________________ Penalty for making a false statement: Fine of up to $250,000 or up to 5 years imprisonment or both. 18 U.S.C. ยงยง 152 and 3571. 11-19-03 American LegalNet, Inc. www.FormsWorkflow.com
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