CACB — Application for Payment of Unclaimed Funds

Source: https://www.cacb.uscourts.gov/sites/cacb/files/documents/forms/form_1340_application_unclaimed_funds.pdf

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

Case number:

Form 1340 (12/23)

APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS

1. Claim Information

For the benefit of the Claimant(s)1 named below, application is made for the payment of unclaimed funds on deposit with 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 Claimant

Amount:

Claimant’s Name:

Claimant’s Current Mailing

Address, Telephone Number, and Email Address:

2. Claimant Information

Applicant2 represents the following:

□ The Claimant is the Owner of Record3 entitled to the unclaimed funds appearing on the records of the court. □ The Claimant (Successor Claimant) is entitled to the unclaimed funds by transfer, assignment, purchase, merger, acquisition, or succession by other means, and below are the name(s) of the Owner of Record and all previous owner(s) of the claim: ______________________________________________________________________________ ______________________________________________________________________________. □ If the Claimant is a Successor Claimant, Applicant has sent a copy of the application to the Owner of Record and all other previous owner(s) of the claim at their current address or Applicant has enclosed a statement explaining why Applicant was not able to do so or an explanation of why doing so is not necessary.

3. Applicant Information

Applicant represents the following:

□ Applicant is the Claimant. □ Applicant is Claimant’s representative (e.g., attorney or unclaimed funds locator). □ Applicant is a representative of the deceased Claimant’s estate.

1 The Claimant is the party entitled to the unclaimed funds. 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. 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.

5. 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 Central District of California Civil Process Clerk-Federal Building

300 North Los Angeles Street, Room 7516 Los Angeles, CA 90012

6. Applicant Declaration 6. 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 that perjury under the laws of the United States of America the foregoing is true and correct and any fraud in the that the foregoing is true and correct and any fraud in the application or supplemental materials may result in criminal application or supplemental materials may result in penalties, see, e.g, 18 U.S.C. § 152. criminal penalties, see, e.g. 18 U.S.C. § 152.

Date: ____________________________ Date: ____________________________

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Signature of Applicant Signature of Co-Applicant (if applicable)

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Printed Name of Applicant Printed Name of Co-Applicant (if applicable)

Address: Address:

Telephone: ________________________ Telephone: ________________________

Email: _______________________ Email: _______________________

7. Notarization

A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

STATE OF

COUNTY OF

This Application for Unclaimed Funds, dated was subscribed and sworn to (or affirmed) before me on this____day of________________, 20____by

who proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.

(SEAL) Notary Public

Form 1340 Application for Payment of Unclaimed Funds Page 2