Form B1340 "Application for Payment of Unclaimed Funds"

What Is Form B1340?

This is a legal form that was released by the United States Bankruptcy Court on December 1, 2019 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2019;
  • The latest available edition released by the United States Bankruptcy Court;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form B1340 by clicking the link below or browse more documents and templates provided by the United States Bankruptcy Court.

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Download Form B1340 "Application for Payment of Unclaimed Funds"

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Fill in this Information to identify the case:
Debtor 1
______________________________________________
First Name
Middle Name
Last Name
Debtor 2
______________________________________________
(Spouse, if filing) First Name
Middle Name
Last Name
United States Bankruptcy Court for the: _________ District of ______________
(State)
Case number:
Form 1340 (12/19)
APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS
1. Claim Information
For the benefit of the Claimant(s)
named below, application is made for the payment of unclaimed funds on deposit with
1
the court. I have no knowledge that any other party may be entitled to these funds, and I am not aware of any dispute
regarding these funds.
Note: If there are joint Claimants, complete the fields below for both Claimants.
Amount:
Claimant’s Name:
Claimant’s Current Mailing
Address, Telephone Number,
and Email Address:
2. Applicant Information
Applicant
represents that Claimant is entitled to receive the unclaimed funds because (check the statements that
2
apply):
Applicant is the Claimant and is the Owner of Record
entitled to the unclaimed funds appearing on the records of
3
the court.
Applicant is the Claimant and is entitled to the unclaimed funds by assignment, purchase, merger, acquisition,
succession or by other means.
Applicant is Claimant’s representative (e.g., attorney or unclaimed funds locator).
Applicant is a representative of the deceased Claimant’s estate.
3. Supporting
Documentation
Applicant has read the court’s instructions for filing an Application for Unclaimed Funds and is providing the required
supporting documentation with this application.
The Claimant is the party entitled to the unclaimed funds.
1
2
The Applicant is the party filing the application. The Applicant and Claimant may be the same.
3
The Owner of Record is the original payee.
Fill in this Information to identify the case:
Debtor 1
______________________________________________
First Name
Middle Name
Last Name
Debtor 2
______________________________________________
(Spouse, if filing) First Name
Middle Name
Last Name
United States Bankruptcy Court for the: _________ District of ______________
(State)
Case number:
Form 1340 (12/19)
APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS
1. Claim Information
For the benefit of the Claimant(s)
named below, application is made for the payment of unclaimed funds on deposit with
1
the court. I have no knowledge that any other party may be entitled to these funds, and I am not aware of any dispute
regarding these funds.
Note: If there are joint Claimants, complete the fields below for both Claimants.
Amount:
Claimant’s Name:
Claimant’s Current Mailing
Address, Telephone Number,
and Email Address:
2. Applicant Information
Applicant
represents that Claimant is entitled to receive the unclaimed funds because (check the statements that
2
apply):
Applicant is the Claimant and is the Owner of Record
entitled to the unclaimed funds appearing on the records of
3
the court.
Applicant is the Claimant and is entitled to the unclaimed funds by assignment, purchase, merger, acquisition,
succession or by other means.
Applicant is Claimant’s representative (e.g., attorney or unclaimed funds locator).
Applicant is a representative of the deceased Claimant’s estate.
3. Supporting
Documentation
Applicant has read the court’s instructions for filing an Application for Unclaimed Funds and is providing the required
supporting documentation with this application.
The Claimant is the party entitled to the unclaimed funds.
1
2
The Applicant is the party filing the application. The Applicant and Claimant may be the same.
3
The Owner of Record is the original payee.
4. Notice
to United States Attorney
Applicant has sent a copy of this application and supporting documentation to the United States Attorney,
pursuant to 28 U.S.C. § 2042, at the following address:
Office of the United States Attorney
District of
[Court enters address here]
5. Applicant Declaration
5. Co-Applicant Declaration (if applicable)
Pursuant to 28 U.S.C. § 1746, I declare under penalty of
Pursuant to 28 U.S.C. § 1746, I declare under penalty of
perjury under the laws of the United States of America
perjury under the laws of the United States of America
that the foregoing is true and correct.
that the foregoing is true and correct.
Date: ____________________________
Date: ____________________________
_______________________________________________
_____________________________________________
Signature of Applicant
Signature of Co-Applicant (if applicable)
_______________________________________________
_____________________________________________
Printed Name of Applicant
Printed Name of Co-Applicant (if applicable)
Address:
Address:
Telephone:
________________________
Telephone:
________________________
Email:
_______________________
Email:
_______________________
6. Notarization
6. Notarization
STATE OF
STATE OF
COUNTY OF
COUNTY OF
This Application for Unclaimed Funds, dated
This Application for Unclaimed Funds, dated
was subscribed and sworn to before
was subscribed and sworn to before
me this
day of
, 20
by
me this
day of
, 20
by
who signed above and is personally known to me (or
who signed above and is personally known to me (or
proved to me on the basis of satisfactory evidence) to be
proved to me on the basis of satisfactory evidence) to be
the person whose name is subscribed to the within
the person whose name is subscribed to the within
instrument. WITNESS my hand and official seal.
instrument. WITNESS my hand and official seal.
(SEAL)
Notary Public
(SEAL)
Notary Public
My commission expires:
My commission expires:
Form 1340
Application for Payment of Unclaimed Funds
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