Petition For Unclaimed Funds And Order Thereon {WAW-118-FI}

<document>COURT COUNTY OFUNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF WASHINGTON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.NO.In reJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)PETITION FOR UNCLAIMED FUNDS AND ORDER THEREONDebtor.I, the undersigned petitioner, under penalty of perjury under the laws of the United States of America, declare (or certify, verify or state) thatthe following statements and information are true and correct:1.I am petitioning to receive the total amount of $which is the sum of all monies deposited with the Court by the case trustee on. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .the following date(s)on behalf of the creditor.2.[Please check and complete the applicable subparagraph below]:THE PEOPLE OF THE STATE OF NEW YORK TOA.I am the creditor named in paragraph 1.B.I am an employee of the creditor named in paragraph 1 and my title is. The creditor is stilllegally entitled to the monies and I am authorized by the creditor to file this petition. C.I am the lawful attorney-in -fact for the creditor named in paragraph 1 and I am duly authorized by the attached power of attorney to file this petition. I am aware of all pertinent statelaw requirements regardingsuch powers of attorney. The following is the creditor's address and phone number, and a brief history of the creditor (from filing of the claim to present), which includes, if applicable, identification of any sale of the company and the new prior owner:GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomD.Subparagraphs A, B, &amp; C above do not apply, but I am entitled to payment of such monies because (state basis for your claim):Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,3.I understand that, pursuant to 18 U.S.C. § 152, I may be fined not more than $5,000, or imprisoned not more than five years, or both, if I have knowingly and fraudulently made any false statements in this document.(Attorney must sign above and type name below)4.On, a copy of this document (fully completed) was mailed to the U.S. Attorney, 601 Union Street, Suite 5100, Seattle, WA 98101-3903, per 28 U.S.C. § 2042.Date executed by Petitioner.Type or Print Petitioner's Name and TitleAttorney(s) forPetitioner's signaturePetitioner's current phone numberSworn and subscribed to, before meOffice and P.O. Addressthisday ofPetitioner's AddressTelephone No.: Facsimile No.: E-Mail Address:Notary Public for State of Washington,APPROVED AS TO FORM:residing at:Financial ClerkMobile Tel. No.:Commission Expires:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IT IS ORDERED that the Clerk of the Bankruptcy Court shall disburse to petitioner the amount of:::::::Index No..Calendar No.DATED.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)UNITED STATES BANKRUPTCY JUDGEPETITION FOR UNCLAIMED FUNDS AND ORDER THEREON (Rev. 6/5/00) WAW-118-FI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com</document>