"Application Form for Claim to Funds" - County of Fulton, Indiana

Application Form for Claim to Funds is a legal document that was released by the Indiana Judicial Branch - a government authority operating within Indiana. The form may be used strictly within County of Fulton.

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Download "Application Form for Claim to Funds" - County of Fulton, Indiana

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Fulton Circuit and Superior Courts
Teri Furnivall, Clerk
815 Main St., Rochester, IN 46975
Telephone: 574-223-4824 Fax: 574-223-8304
INDIANA UNCLAIMED COURT PROPERTY
Application for Claim to Funds Under IC 32-34-3-3:
1.
Complete and sign four (4) copies of the Application for Claim.
NOTE: Information required to complete this form may be obtained through
www.indianaunclaimed.gov and by requesting a Chronological Case Summary from
the Fulton County Clerk’s Office, 574-223-4824.
Attach a copy of your valid Driver’s license with your current address and
2.
telephone number to each Application for Claim.
Order on Application for Claim to Funds Under IC 32-34-3-3:
1.
Complete four (4) copies of the Order on Application for Claim.
Submit all documents to the Fulton County Clerk’s Office in person or by mail:
Fulton County Clerk’s Office
815 Main St.
Rochester, IN 46975
Fulton Circuit and Superior Courts
Teri Furnivall, Clerk
815 Main St., Rochester, IN 46975
Telephone: 574-223-4824 Fax: 574-223-8304
INDIANA UNCLAIMED COURT PROPERTY
Application for Claim to Funds Under IC 32-34-3-3:
1.
Complete and sign four (4) copies of the Application for Claim.
NOTE: Information required to complete this form may be obtained through
www.indianaunclaimed.gov and by requesting a Chronological Case Summary from
the Fulton County Clerk’s Office, 574-223-4824.
Attach a copy of your valid Driver’s license with your current address and
2.
telephone number to each Application for Claim.
Order on Application for Claim to Funds Under IC 32-34-3-3:
1.
Complete four (4) copies of the Order on Application for Claim.
Submit all documents to the Fulton County Clerk’s Office in person or by mail:
Fulton County Clerk’s Office
815 Main St.
Rochester, IN 46975
STATE OF INDIANA
CAUSE NO. ________________________
COUNTY OF FULTON
PA NO. ____________________________
APPLICATION FOR CLAIM TO FUNDS UNDER IC 32-34-3-3
Comes now, _________________________ a party to this case, and make application
NAME
under I.C. 32-34-3-3 for a claim to funds previously held by the Clerk of Fulton County since
released to the Indiana Attorney General. In support of this application
________________________ states:
NAME
1.
The payment of $_______________ was received by the Fulton County Clerk.
2.
I have since learned that the Fulton County Clerk was holding monies for my benefit
under this Cause or PA number.
3.
In compliance with IC 32-34-3-3, the Fulton County Clerk delivered to the Indiana
Attorney General $____________________ which was collected in the Clerk’s
office. These funds were sent to the Indiana Attorney General on the ______ day of
______________, 20_____ after the Clerk held them for the maximum of five years.
4.
I am the rightful owner of the $________________held by the Clerk of Fulton
County and now on deposit with the State of Indiana as unclaimed property.
Wherefore, I pray this Court schedule a hearing on this Application for Claim to Funds under
IC 32-34-3-3, or in the alternative, grant this Application without further hearing if satisfied as to my
claim. Furthermore, I pray that this Court order the release of the monies now held by the State of
Indiana for proper disbursement to me pursuant to IC 32-34-3-3.
______________________________________
Signature
I verify under the penalty of perjury that the foregoing representatives are true and correct to
the best of my knowledge and belief.
______________________________________
Signature
Distribution: Indiana Attorney General, Unclaimed Property Division
Property ID: ______________________________
STATE OF INDIANA
IN THE FULTON CIRCUIT/SUPERIOR COURT
COUNTY OF FULTON
CAUSE NO. ________________________
____________________________
Plaintiff
VS
____________________________
Defendant
ORDER ON APPLICATION FOR CLAIM TO FUNDS UNDER IC 32-34-3-3
________________________ filed a Verified Application to Funds under IC 32-34-3-3.
NAME
The Court finds from the Verified Application that the Indiana Attorney General received
notice of this proceeding more than ten (10) days before today’s date. The Indiana Attorney General
has not filed an objection.
The Court finds that the Fulton County Clerk previously delivered the sum of
$_________________ to the Indiana Attorney General pursuant to IC 32-34-3-2.
The Court now ORDERS the Indiana Attorney General to direct the Treasurer of the State of
Indiana to return the sum of $_________________ to the Claimant.
SO FOUND AND ORDERED THIS ______ DAY OF _________________, 20______.
______________________________________
Judge, ______________________ Court
Distribution: Indiana Attorney General, Unclaimed Property Division
Property ID: _____________________________
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