Aug 23 04 03:17p

Cheiralogic Partners

Bankof America __..
Bank of Auorica, N.A. See
BO. Box 25118 id

Tapa, PE ash22-6 114

7816478433

Page 3 of 2
Stutiment Period

07-21-04 through 06-19-04

Number of checks enclosed: 0
B20 CP 12 000047.

Account: Number: 0034 3909 8764

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0000124 1MB 0.309 04 20075 001 SCN999 11 34
JENNY E FREEMAN

59 ASH ST
WESTON MA 02493-1927

Our free Online Banking scrvicc allows you to check balances, track account activity,
pay bills and more. With Online Banking you can a)so view up to 18 months of this statement
online and even turn off delivery of your paper statement. Enrol] at wew.bankofamerica.com.

Custonier Service Information
www.bankofamerica.com

Or you may ‘write to:
Bunk of America

you may call:

-For additional ‘information or service,

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EXHIBIT ©
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UNITED STATES BANKRUPTCY COURT

Northern District of Texas

Earle Cabell Federal Building and U.S. Courthouse
1100 Commerce Street, Room 12A24
Dallas, Texas 75242-1496

TAWANA C,. MARSHALL
CLERK OF CourT

United States Attorney
3rd Floor

1100 Commerce Street
Dallas, TX 75242

RE: Application for Payment of Unclaimed Funds
Bankruptcy Case Number: 391-31265-RCM-11
Debtor: Affiliated Food Group Benefit Trust
Claimant: Jenny E. Freeman, M.D.

Dear Sir:

Enclosed herewith is a copy of an Application for Payment of Unclaimed Funds which is
forwarded to your office pursuant to 28 U.S.C. 2042.

Absent the filing of an objection by your office within 20 days of this transmittal an Order
directing payment of the unclaimed funds will be forwarded to the Bankruptcy Judge for
signature.

DATE OF TRANSMITTAL: 12/20/2004

Sincerely yours,
Tawana Marshall
CLERK GF COURT

py: Wiebert Bryan*
Deputy Clerk



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Nov 29 2004 12:35PM OEMUSER 425-9520612 p-3

UNITED STATES BANKRUPTCY COURT
NORTHERN DISTRICT OF TEXAS

Tn Re:
§
§ Case No.: 391-3 1263
5
Debtor(s) 3 Affidavit of Jenny E, Frociman
Affiliated Food Group Trust §
§
§

1, Jonny E. Freeman, MD, under the penalty of perjury of the laws af ike United States of Americe declare
(or certify, verify or state) the following statements ere true and correct:

Ll Iwas a creditor in the bankruptcy of Affiliated Food Group Benefit Trust. Case No. 391-
31265.

2. Al the time of the bankruptcy my address of record was:

800 54S. #4410
Fort Worth TX 78104

3. Asso much time has gone by since the case was filed, | no longer have any correspondence
showing this address or other paperwork concerning tie case.

4. My current address aud telephone number are:

>Conemntei, «59 fry ST
WestorMAbnusity WEStm MA O2483

Phone: 781.760.5569

Signed this 7 day of is oy _.2004

sipeine 2

=

NOTARY ACKNOWLEDGMENT

State of _A4aos. } Conaty of, Practobleseyy

Before me, Jenny Freeman. personally appeared and acknowledged to me thatshe/she is the person whose
‘name is subscribed within the instrument and ackuowledged that the execution thereof to be Aisher free
act.

Identification for the ubove named was Driver's License (or specify other identification :)
Mass be,

Signed this_} dayof_ Dee. 2004 DEBORAH A. BOADJOUNDUIAN

Notary Seal Notary Public
Notary Public Signature: Bie Engel ire @ ifs My Como Expiees

Residing At #5 Canora, (owe Aietrere , ty,

EXHIBIT ° _
pagel ofl __

11/29/2004 02:38PM


Nov 29 2004 12:35PM OEMUSER 425-9520612 p.2

U.S. BANKRUPTCY COU’ }
OF TEXAS.

ORIGINA| -ELEED

DRT HES O04
UNITED STATES BANKRUPTCY COURT
NORTHERN DISTRICT OF TEXAS] awa G MARSHALL CLERK

TW Re: Br Deputy
Case No.: 391-1265 ~ PLAN +i

Debtor(s)
Affiliated Food Groap Trust

ten A Un en en te thee

APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS

Comes now the nudersigned, to make application for an order directing payment of unclaimed funds
‘now on deposit in the Treasury of the United States. Claimant isa ___x_ creditor debtor (check onc)
in the above captions bankruptcy case and on whose behalf thee fonds were deposited.

Name of Claimant Jenny 5 Freeman, MD

Name of Business Entity

Title of Officer/Represemiative (if claimant is a business entity)
Mailing Address 59 Ash St.

City Weston State MA Zip 02493-1927
Telephone Number: Home = Work (781) 647-8422
SSt# @iMgb7315 Tax De

Amount Being Claimed $4332.28

T, Jonny E. Freeman MD, do hercby state under penalty of perjury that Tam legally entitled to claim
these funds for whom the unclaimed funds were deposited into the treasury in the above reference
bankruptcy case. | certify to the best of my knowledge that all information submitted in support of this,

claim is tme and correct.
Date Uy x fo

—S the RAW
Claimant Signature Co-Claimant Signature
Subsctibed and Sworn to Before Me this _/ Sr~_ day of hoo .
$5 DEBORAH R. BORDSOUKDWAN — Notary Public 3
Notary Public Inané for the State of rasachucsetin~
B) Conwtion weaiti of Massachusetts
My ots eee My Commission Expires: _ 4/7 /o G

11/29/2004 02:38PM


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JENNY ELLEN

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UNITED STATES OF AMERICA.

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U. §, BANKRUPTCY COURT

IN THE UNITED STATES BANKRUPTCY COURT E N TERED

FOR THE NORTHERN DISTRICT OF TEXA‘
DALLAS DIVISION AUG - 8 200
TAWANA
In Re: § By. C. MARSHALL CLERK
cee,
§ Deputy
Affiliated Food Group § Case No:391-31265-RCM-11

Benefit Trust §
Debtor(s) §
§

ORDER DISBURSING FUNDS FROM REGISTRY AND
DEPOSITING FUNDS INTO UNCLAIMED FUNDS

The Court, after review of the file, finds this case was closed on August 17, 1999. and
reopened on September 7, 1999 for the limited purpose of depositing $73,537.07 into the Registry
of the Court. The funds represent unclaimed insurance premiums. There being no further need for
the funds to be held by the Clerk in the Registry of this Court, it is.

ORDERED that the Clerk disburse $73, 537.07 plus all acctued interest to the United States
Bankruptcy Court, 1100 Commerce Street, RM 12A24, Dallas, TX 75242. It is further

ORDERED that the $73,537.07 representing dividends due to individual claimants on
Exhibit “A” be deposited into unclaimed funds, and the accrued interest is forfeited to the Treasury
of the United States, It is further

ORDERED this case shall be closed without further order of this Court.

DATE: Z

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