United States Bankruptcy Court For The Western District Of Oklahoma Page 2

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UNITED STATES BANKRUPTCY COURT
FOR THE WESTERN DISTRICT OF OKLAHOMA
IN RE:
)
)
Case No. _____-_________-_____
)
)
Chapter _____
Debtor(s).
)
APPLICATION FOR ORDER DIRECTING PAYMENT
OF UNCLAIMED FUNDS TO CREDITOR/CLAIMANT
A dividend/refund check in the above-named case issued to the payee, _______________
__________________________________________, in the amount of $____________, was not
cashed by said payee, and, pursuant to 11 U.S.C. § 347(a) of the Bankruptcy Code, the trustee
paid this unclaimed money to the Registry of the Clerk, United States Bankruptcy Court.
The undersigned creditor/claimant has made sufficient inquiry and has no knowledge that
this claim has been previously paid, that any other application for this claim is currently pending
before this Court, or that any other party other than this Applicant is entitled to submit an
application for this claim.
Applicant has provided notice to the U.S. Attorney pursuant to 28 U.S.C. § 2042.
THEREFORE, Application is hereby made for the Clerk, U.S. Bankruptcy Court, to pay
this unclaimed money to
_______________________________
____________________________________
Date
Signature of creditor/claimant
_______________________________
___________________________________
Tax ID or last 4 numbers of SSN
Print name of creditor/claimant

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