Free Motion for Disbursement of Unclaimed Funds - North Carolina

Local Form 5

July 2007

UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF NORTH CAROLINA _______________ Divison
In re: ) ) ) ) ) ) ) ) ) Case No.: Chapter:

Debtor(s)

MOTION FOR DISBURSEMENT OF UNCLAIMED FUNDS hereby moves the Court for an order (Claimant(s) Name) directing the United States Bankruptcy Court to disburse the sum of $ (Enter amount of claim) from the Court's registry fund, payable to (Claimant(s) Name) unclaimed funds previously deposited with the Court. Date _______________ Supporting documentation attached ____yes ____no I understand that pursuant to 11 U.S.C. §§ 152 and 3571, I may be fined up to $500,000, imprisoned for up to 5 years or both if I have knowingly and fraudulently made any false statements in this document or provided false and fraudulent documentation as part of this application. _____________________________________ Signature of Claimant _____________________________________ Typed or printed name of Claimant _____________________________________ Address of Claimant _____________________________________ Daytime Telephone Number of Claimant , representing

IN THE UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF NORTH CAROLINA ________________ DIVISION
In re: ) ) ) ) ) ) ) Case No.: Chapter:

Debtor(s).

NOTICE OF HEARING AND CERTIFICATE OF SERVICE NOTICE IS HEREBY GIVEN that the Court will conduct a hearing on ________________ at ___________ (a.m./p.m.) in Courtroom number ________ located at ___________________ to consider the Motion for Disbursement of Unclaimed Funds filed by _____________________. (Claimant(s) Name) NOTICE IS FURTHER GIVEN to the Court that on ____________________, the (Enter date parties served) United States Attorney, the case trustee, and the Bankruptcy Administrator were served a copy of the Motion for Disbursement of Unclaimed Funds and this Notice of Hearing by U. S. Mail.

Signature of Claimant(s)

Typed or printed name of Claimant(s)

Date _______________________

2