Affidavit Of Creditor (Re Unclaimed Funds) | Pdf Fpdf Doc Docx | Indiana

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Affidavit Of Creditor (Re Unclaimed Funds) | Pdf Fpdf Doc Docx | Indiana

Affidavit Of Creditor (Re Unclaimed Funds)

This is a Indiana form that can be used for Southern District within Federal, Bankruptcy Court.

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United States Bankruptcy Court Southern District of Indiana IN RE: DEBTOR(S) ) ) ) ) ) CASE NO. AFFIDAVIT OF CREDITOR I, the above referenced case declare as follows: 1. (Name and Address) has been granted a Power of Attorney by me to submit an Application for Payment from Unclaimed Funds seeking payment in the amount of in the above referenced bankruptcy case. 2. My name, position with company (if applicable), address and telephone number are as follows: Name: Position: Address: City/State/ZIP: Area code/telephone number: due and owing me as a creditor , the undersigned creditor in 3. That the undersigned substantiate the creditor has rights to the claim, including but not limited to documents relating to sale of company; i.e., purchase agreements and/or stipulation by prior and new owner as to right of ownership of funds by the attachment of certified copies of all necessary documents. 4. I (or the company which I represent) have neither previously received remittance for this claim nor have contracted with any other party other than the person named in item one above to recover these funds. American LegalNet, Inc. www.FormsWorkFlow.com I hereby certify that the foregoing statements are true and correct to the best of my knowledge and belief. Dated _______________________________________ Creditor Sworn to and Subscribed before me this _____ day of _________________, 20__. ___________________________________ NOTARY PUBLIC, AT LARGE STATE OF _________________________ SF03470.7 (6/09) American LegalNet, Inc. www.FormsWorkFlow.com

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