United States Bankruptcy Court For The Western District Of Oklahoma Page 3

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___________________________________
Address of creditor/claimant
I hereby certify by my signature above, that a copy of this Application was mailed on the
________ day of __________________, 20_______, to the United States Attorney, 210 Park
Avenue, Suite 400, Oklahoma City, OK 73102 and to the following:
Panel Trustee
Assistant United States Trustee
Debtor
Debtor’s Attorney, if any
Original Claimant, if different
Original Claimant’s Attorney, if discernible
___________________________________
Signature of creditor/claimant

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