CASB — Application for Payment of Unclaimed Funds

Source: https://www.casb.uscourts.gov/sites/casb/files/documents/forms/Application%20%28Form%201340%202023-12%29.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

United States Bankruptcy Court for the: Southern District of California

Case number:

Form CSD1340 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 Claimants Amount: $

Claimant’s Name:

Claimant’s Current:
• Mailing Address
• Telephone Number
• Email Address:

2. Claimant Information (must check 1 box)

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 (must check 1 box)

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

   Southern District of California

   880 Front St Ste 6293 San Diego, CA 92101

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: ____________

---

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

---

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

Address: Address:

Telephone: Telephone:

Email: Email:

7. Notarization 7. Notarization STATE OF STATE OF

COUNTY OF COUNTY OF

This Application for Unclaimed Funds, dated This Application for Unclaimed Funds, dated was subscribed and sworn to before was subscribed and sworn to before me this day of , 20 by me this day of , 20 by

who signed above and is personally known to me (or who signed above and is personally known to me (or proved to me on the basis of satisfactory evidence) to be proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within the person whose name is subscribed to the within instrument. WITNESS my hand and official seal. instrument. WITNESS my hand and official seal.

(SEAL) (SEAL)

Notary Public Notary Public

My commission expires: _____________ My commission expires: _____________

Form 1340 Application for Payment of Unclaimed Funds Page 2