WPC |\EҠUTztӠU;P?$|]x$%1YV{}W,$ @v6gpvė\ ~w>Rv/J͌L\b3uo~C3#.0 HTx =ZQ+l L:1Ot  z0_݆-u,*Nxe|bs"3+(]C[A}Ȧ#0{#XT,lXvy0K5 OKv4Iw-F9[Tă+Z*'9|W/i|2!r ˆe:#դGPJmkj{ҼPhSO(\\AqկX#U N % 0( ^  w! 4% 9 H mJ 0ca 1u 0w9 0 0: 0 0 0U 00 1  1 N' 72)e [2eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee BHP LaserJet 4050 Series PCL6,,,,0(9 Z6Times New Roman RegularX($6 c6:i+003|xU(;3$2#  0  .3  0  3#37=CIQYag1.a.i.(1)(a)(i)1)a)(O;$0  2#  a  .3  0` (#(#(b$0  0` (#(#2#   .3  0 ` (#` (#(xir$0  0` (#(#0 ` (#` (#2#(  0  )3  0 (# (#($0  0` (#(#0 ` (#` (#0 (# (#2#(  a  )3  0h(#(#(F$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#2#(   )3  0h(#h(#($0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#2#  0  )3  0(#(#({$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2#  a  )3  0p(#(# xAGaeimquy}Bullet ListBullets List x"CW[_cgkosCheck BoxCheck Box&&&&&&&& i)  Newnan ies BLR d !  _  INFORMATIONANDDOCUMENTATIONREQUIRED  n  FORPETITIONFORUNCLAIMEDFUNDS  X   I.Arequest BYANOWNEROFRECORD forpaymentofUnclaimedFundsmustincludethe  d followingdocuments:  P   (Ax3 " 3"   32A3  0    Petition forPaymentofUnclaimedFunds,whichmustincludethefollowing: 3 ݌ " (#(# Ќ  ! !  ("xx " 3"     32"&3  0 `   Thedebtorsname 3݌ ` (#` (# Ќ  " 3"     3]2"&3  0 `   TheChapternumber(7,11or13) 3]݌ ` (#` (# Ќ  " 3"     3?2"&3  0 `   Thecasenumberfollowedbythejudgesinitials 3?x݌ ` (#` (# Ќ  " 3"     342"&3  0 `   Thecompletenameofthepartyclaimingthefunds( Claimant) 34m݌y ` (#` (# Ќ  " 3"     3=2"&3  0 `   Claimantssocialsecuritynumberortaxidentificationnumber 3=v݌b ` (#` (# Ќ  " 3"     3C2"&3  0 `   Claimantspreviousaddress 3C|݌K` (#` (# Ќ  " 3"     3# 2"&3  0 `   Claimantscurrentaddress 3# \ ݌4` (#` (# Ќ  " 3"     3 2"&3  0 `   Theamountoftheclaim 3 ; ݌m` (#` (# Ќ  " 3"     3 2"&3  0 `   Claimantssignature 3  ݌V` (#` (# Ќ    IfClaimantisan individua l,Claimantssignaturemustbe notarized or,iftheindividual ? isrepresentedbyanattorney,thepetitionmustbe verified . AClaimantwhoisanindividualalso + mustattachtothePetitiona copyofhisorherdriverslicenseandacopyofhisorhersocial  securitycard .     IfClaimantisa corporation ,thePetitionmustbesignedbyacorporateofficer,mustcontain   thecorporateseal andmustcontainastatementofthesigningofficersauthority.Ifthecorporation  isrepresentedby anattorney,thepetitionmustbeaccompaniedbyacorporateresolutionsignedby w acorporateofficer,containingthecorporatesealandcontainingastatementofthesigningofficers ` authority. I   IfClaimantisa partnership, thePetitionmustbesignedbythegeneralpartner(s)andmust 2 containastatementofthesigningpersonsauthority.Ifthepartnershipisrepresentedbyan  n attorney,thepetitionmustbe verified bythegeneralpartner(s),containingastatementofthe !W signingofficersauthority. !C  ! !  (Axx  " 3"   32A3  0    A certificateofservice showingserviceofacopyofthepetition 3݌#"(#(# Ќ  ! !  ("xx " 3"     3z2"&3  0 `   upontheU.S.Attorneyand 3z݌$ #` (#` (# Ќ  " 3"     3W2"&3  0 `   uponanyotherpartywhomayhaveaninterestinthefunds 3W݌% $` (#` (# Ќ  ! !  (Axx " 3"   32A3  0    Aproposed order directingpaymenttoClaimant,andincludesthefollowing: 3#݌l'"&(#(# Ќ  ! !  ("xx " 3"     32"&3  0 `   ThedatethefundswereoriginallyremittedtotheRegistryoftheCourt 3݌X(#'` (#` (# Ќ  " 3"     32"&3  0 `   Theamountoftheclaim 3݌A)$(` (#` (# Ќ  " 3"     32"&3  0 `   Claimantsfullnameandcorrectaddress 3݌**z%)` (#` (# Ќ   +L'+ II.Arequest BYASUCCESSORININTEREST forpaymentofUnclaimedFundsmustinclude  thefollowingdocuments: n   (Axx " 3"   32A3  0    Petition forPaymentofUnclaimedFunds,whichmustincludetheinformationsetforth @  above, plusthefollowing:  3݌, |(#(# Ќ  ! !  ("xx " 3"     32"&3  0 `   Thefullnameoftheoriginalownerofthefunds. 3݌ h` (#` (# Ќ  " 3"     32"&3  0 `   Theoriginalownerssocialsecuritynumberortaxidentificationnumber 3݌ Q` (#` (# Ќ  " 3"     32"&3  0 `   Theoriginalownerspreviousaddress 3݌ : ` (#` (# Ќ  " 3"     3~ 2"&3  0 `   AbriefstatementofthefactsbywhichClaimantacquiredtherightsassuccessorin  #  interesttotheoriginalownerofthefunds. 3~ ݌ ` (#` (# Ќ    CopiesofdocumentswhichshowthatClaimantisentitledtopaymentofthefundsasa   successorininteresttotheoriginalownerofthefundsshouldbeattachedtothePetition.Copies   ofanydocumentsfromaprobateorothercourtmustbecertifiedcopies. w  ! !  (Axx " 3"   3#2A3  0    A certificateofservice showingserviceofacopyofthepetition 3##݌I(#(# Ќ  ! !  ("xx " 3"     3h%2"&3  0 `   upontheU.S.Attorney, 3h%%݌5` (#` (# Ќ  " 3"     3B&2"&3  0 `   upontheoriginalowner,ifappropriate,and 3B&{&݌n` (#` (# Ќ  " 3"     31'2"&3  0 `   uponanyotherpartywhomayhaveaninterestinthefunds. 31'j'݌W` (#` (# Ќ  ! !  (Axx " 3"   3(2A3  0    Aproposed order directingpaymenttoClaimant,andincludesthefollowing: 3((݌)(#(# Ќ  ! !  ("xx " 3"     3z*2"&3  0 `   ThedatethefundswereoriginallyremittedtotheRegistryoftheCourtandthename  oftheoriginalowner 3z**݌` (#` (# Ќ  " 3"     3+2"&3  0 `   Theamountoftheclaim 3++݌` (#` (# Ќ  " 3"     3,2"&3  0 `   Claimantsfullnameandcorrectaddress 3,,݌` (#` (# Ќ  III.Arequestby AREPRESENTATIVECLAIMANT (suchasaFundLocator)forpaymentof R UnclaimedFundsmustincludethefollowingdocuments: >   (Axx " 3"   3.2A3  0    Petition forPaymentofUnclaimedFunds,whichmustincludealltheinformationrequired  ` innumberIandIIabove(ifapplicable), plusthefollowing:  3..݌ L(#(# Ќ  ! !  ("xx " 3"     302"&3  0 `   Ifavailable,theoriginalownerscurrentaddress. 301݌!8 ` (#` (# Ќ  " 3"     312"&3  0 `   AbriefstatementoftheauthorityunderwhichtheRepresentativeClaimantis "!! assertingaclaimtothefunds. 311݌# "` (#` (# Ќ  " 3"     3 32"&3  0 `   IftheRepresentativeClaimantisassertingaclaimonbehalfofasuccessortothe $# originalowner,thefullname,currentaddress,socialsecuritynumberortaxID % $ numberofthesuccessor,andabriefstatementofthefactsbywhichthesuccessor u&!% acquiredrightstothefunds.  3 3B3݌^'"&` (#` (# Ќ    CopiesofdocumentswhichshowtheauthorityunderwhichtheRepresentativeClaimantis G(#' assertingaclaimtothefundsshouldbeattachedtothePetition,exceptthatiftheRepresentative 0)$( Claimantisproceedingunderapowerofattorney,anoriginalpowerofattorneyform,which *i%) conformstoGeorgialawandwhichcontainsanotarizedsignature. +R&*   +;'+ ! !  (Axx " 3"   372A3  0    A certificateofservice showingserviceofacopyofthepetition 377݌(#(# Ќ  ! !  ("xx " 3"     3/92"&3  0 `   upontheU.S.Attorney, 3/9h9݌` (#` (# Ќ  " 3"     3 :2"&3  0 `   uponthepartyforwhosebehalftheclaimisasserted,and 3 :B:݌n` (#` (# Ќ  " 3"     3;2"&3  0 `   uponanyotherpartywhomayhaveaninterestinthefunds. 3;?;݌W` (#` (# Ќ  ! !  (Axx " 3"   3<2A3  0    Aproposed order directingpaymenttoClaimant,andincludesthefollowing: 3<<݌) y(#(# Ќ  ! !  ("xx " 3"     3O>2"&3  0 `   ThedatethefundswereoriginallyremittedtotheRegistryoftheCourtandthename  e oftheoriginalowner 3O>>݌ N` (#` (# Ќ  " 3"     3?2"&3  0 `   Theamountoftheclaim 3??݌ 7 ` (#` (# Ќ  " 3"     3i@2"&3  0 `   Claimantsfullnameandcorrectaddress 3i@@݌ ` (#` (# Ќ  IV.Hearings     Thepetitionmaybegrantedwithoutahearing.Ifahearingisscheduled,thecourtwillsend t  anoticeofthedateandtimeforthehearingtoallinterestedparties. ]  V.Fraud /   AnyPetitionforUnclaimedFundswhichappearstobebaseduponfraudwillbereferredto Q theU.S.Attorneyforinvestigationandprosecution. : VI.Forms     SuggestedformsforuseinconnectionwithaPetitionofUnclaimedFundsareattachedto  thisinformationsheet.  w @ UNITEDSTATESBANKRUPTCYCOURT  @ NORTHERNDISTRICTOFGEORGIA  @aa___________________DIVISION  INTHEMATTEROF:   h 0  :  CHAPTER_______= (#(#    `     h   : & v    `     h   :  CASENO.______________  _    `     h   :  H    `  Debtor(s) h   :  1    PETITIONFORPAYMENTOFUNCLAIMEDFUNDS        Adividendcheckintheamountof$_______________wasissuedintheabovestyled   bankruptcycaseto__[Insertnameoforiginalownersofrecordofthefunds],whose 3  mailingaddressatthetimeofissuewas______________________________________ @ _____________________________________________________________________________.  Becausethatcheckwasnotcashedbysaidpayee,pursuantto11U.S.C.347(a),on J ____________________,200____,TrusteepaidthoseunclaimedfundstotheClerk,U.S. W BankruptcyCourt.    Applicationisherebymadetopaytheseunclaimedfundsto[typeorprintClaimantsname] a  at[insertClaimantscurrentaddress] .[Insertanyfurtherfactsorinformationnecessaryto n establishClaimantsrightstotheUnclaimedFunds.]     This___dayof_______________,20__. -}!    `     h     ___________________________________ s $    `     h     SignatureofClaimant \!%    `     h     ___________________________________ E"&    `     h     SocialSecurityorTaxIDnumber .#~' Sworntoandsubscribedtobefore %P ) methis___dayof________,20__. %9!*    `     h      p   /-XXIfapplicable,affix &""+    `     h      p   CorporateSealXpX/- '", ________________________________ 2(#- NotaryPublicinandforthe )k$. Stateof_________________________ *T%/ Mycommissionexpires____________  *=&0 @ UNITEDSTATESBANKRUPTCYCOURT  @ NORTHERNDISTRICTOFGEORGIA  @aa___________________DIVISION  INTHEMATTEROF:   h 0  :  CHAPTER___________= (#(#    `     h   : & v    `     h   :  CASENO.________________  _    `     h   :  H    `  Debtor(s) h   :  1  @CERTIFICATEOFSERVICE     Theundersigned[typeorprintname]________________________________________ n  of[typeorprintaddress]________________________________________________________ W  _____________________________________________________________________________ @ herebycertifies: )y   ThatIam,andatalltimeshereinaftermentioned,wasmorethan18yearsofage,andthat K onthe____dayof________________,20____,IservedacopyoftheforegoingPetitionfor 4 PaymentofUnclaimedFunds,uponthepartieslistedbelowbyFirstClassMail:  ! !  ("xx " 3"     `  3V2"&3  0   UnitedStatesAttorney 3VCW݌ (# (# Ќ     `  1800RichardRussellFederalBuilding     `  75SpringStreet,SE q    `  Atlanta,Georgia30303 Z ! !  ("xx " 3"     `  3Y2"&3  0   [insertnameandaddressofallotherpartiesserved] 3YY݌,| (# (# Ќ  Executed______________________  By:____________________________________  7    `    (Date) h      p (Signature) !     t% $ X3@ UNITEDSTATESBANKRUPTCYCOURT  @ NORTHERNDISTRICTOFGEORGIA  @ ______/-XXp(Atlanta,Gainesville,NewnanorRome)#XpX/-Z\#___DIVISION j    `     h     INTHEMATTEROF:   h 0  :  CHAPTER_/-XXp[Insert7,11,or13]#XpX/-]#_ Q(#(#    `     h   :  . [TypeDebtor(s)Names],   h   :  CASENO.____________/-XXp [judgesinitials] #XpX/-^#      `     h   :      `  Debtor(s). h   : u   @  ORDERFORPAYMENTOFUNCLAIMEDFUNDS   \  3  On______________,200__,TrusteehereinfiledaNoticeandPaymentintotheCourtfor   UnclaimedFundsandissuedachecktotheClerk,U.S.BankruptcyCourt,fordepositintothe j  RegistryoftheCourtintheamountof$_______________onbehalfofcreditor[Insertnameof  ] originalownerofrecordofthefunds](the UnclaimedFunds).    On__________________,200____,[InsertNameoffundlocator,attorney,creditor,debtor], S attorneyinfactfor_[Insertnameofclaimant]( Claimant)filedaPetitionforPaymentof F UnclaimedFundstocollectthem.Thepetitionandthedocumentsattachedtheretoestablishthat  ClaimantisentitledtotheUnclaimedFunds;accordingly,itishereby <   ORDEREDthattheClerk,U.S.BankruptcyCourt,shallissueacheckintheamountof / $_________payableto_____________________andshallsendsaidchecktopayeeatthe   followingaddress:____________________________________________________________. %!u"   ITISSOORDEREDthisthe_____dayof_______________,20__. "$    `     h   ______________________________________ &^!(    `     h   [JudgesCompleteName] &G")    `     h   UNITEDSTATESBANKRUPTCYJUDGE '0#* &%XXp3Preparedby: ($+ _________________(name) )$, _________________(address) [*%- _________________(telephone,facsimile) $+t&. StateBarNo.______ +='/ _________________(emailaddress) ,(0 Counselfor_________(party(ies)represented) -(1 .(*H.)[FillincounselidentificationandattachaDistributionListasrequiredbyBLR90132(b)] .(*2 x0i+/* #XpX%&g# XXp.vfH:\USERS\AshtonA\WP\unclaimedFunds-instructions.wpdvH:\USERS\AshtonA\WP\unclaimedFunds-instructions.wpd/  #XpX [i#