Expression, Application for Payment of Unclaimed Funds

• Court: United States Federal Court
• Section: United States Federal Court

Form 1340 (12/23)

APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS

1. Claim Information

For the benefit of the Claimant(s) 1 named below, application is made for the payment of unclaimed fu nds on deposit with

the court. I have no knowledge that any other party may be entitled to these f unds, and I am not aware of any dispute

regarding these funds.

Note: If there are joint Claimants, co mplete the fields below for both Clai mant

Amount:

Claimant’s Name:

Claimant’s Current Mailing

Address, Telephone Number,

and Email Address:

2. Claimant Information

Applicant2 repres ents the following:

□

The Claimant is the Owner of Record 3 entitled to the unclaimed funds appearing on the records of t he court.

□

The Claimant (Successor Claimant) is e ntitled to the unclaimed funds by trans fer, assignment, purchase, merger,

acquisition, or succession by other mea ns, and below are the name(s) of th e Owner of Record and all previous

owner(s) of the claim:

________________________________ ___________________________ ___________________

________________________________ ___________________________ ___________________.

□

If the Claimant is a Successor Claima nt, Applicant has sent a copy of the application to the

Owner of Record and all

other previous owner(s) of the claim at t heir current address or Applic ant has enclosed a statement explainin g why

Applicant was not able to do so or an exp lanation of why doing so is not necess ary.

3. Applicant Information

Applicant represents the fol lowing:

□

Applicant is the Claimant.

□

Applicant is Claimant’s representat ive (e.g., attorney or unclaimed f unds locator).

□

Applicant is a representative of the deceased Claimant’s estate.

1 The Claimant is the party entitled to the unclaimed funds.

2 The Applicant is the party filing the ap plication. The Applicant and Clai mant may be the same.

3 The Owner of Record is the original payee .

Debtor 1 _________________________ _____________________

First Name Middl e Name Last Name

Debtor 2 __________________________ ____________________

(Spouse, if filing) First Name M iddle Name Last Name

United States Bankruptcy Court for the: _________ District of ______________

(State)

Case number:

Fill in this Information to identify the case: