Free Affidavit of Service re: Intent to Apply for Release - New York

UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF NEW YORK In re ) ) ) ) ) ) ) ) ) ) ) )

[Set forth here all names including married, maiden, and trade names used by debtor within last 8 years.]

Debtor

Case No. Chapter

Last four digits of Social-Security or Individual TaxPayer-Identification (ITIN) No(s).,(if any): Employer Tax-Identification (EIN) No(s).(if any):

AFFIDAVIT OF SERVICE
Notice is hereby given to the court that on for the Northern District of New York was advised ,via

the U.S. Attomey
,

of the intent of
is

, whose mailing address
, ,

whose last four digits of Social Security or Tax Identification Number is

whose telephone number is
unclaimed funds in the above named case.

, to apply for the release of

Respectfully submitted,

SUBSCRIBED AND SWORN to before day of me this

Affix Seal

Notary Public
F:68(1/25/2008)