UNITED STATE BANKRUPTCY COURT EASTERN DISTRICT OF MICHIGAN
In re: Case No. ______________________ Chapter
AFFIDAVIT OF CLAIMANT I, ________________________________________________, do hereby state that I am the claimant to the unclaimed funds released in this application and that I am, to the best of my knowledge, the legal owner of these funds.
Phone number: Social security number XXX-XXIf claimant is a corporation, the federal tax ID number 1. Claimant History: Substantiate claimant's right to the claim; i.e. if the payment is to an individual, include a copy of driver's license or state identification card. If a corporation, include purchase agreements regarding the right to ownership. Attached are certified copies of all necessary documentation. 2. I (or the company which I represent) neither have previously received remittance for this claim nor contracted with any other party other than the person named in item one above to recover these funds.
Page 2 of 2 Affidavit of Claimant
I declare under penalty of perjury that the foregoing copy is true and correct.
_________ ___ Signature of Claimant
Sworn to and Subscribed before me this ____ day of _________________, 20___
__________________________________ NOTARY PUBLIC AT LARGE STATE OF ________________________