Form 1340 (Application for Payment of Unclaimed Funds) is a Director’s Bankruptcy 

Form. Director’s Bankruptcy Forms are issued under Bankruptcy Rule 9009 by the Director of 

the Administrative Office of the United States Courts.

Form 1340 is a template used by courts in developing their own localized form to assist 

parties in seeking the payment of unclaimed funds held by bankruptcy courts. This template

version of the form should not be filed with the court. Instead, a member of public seeking 

payment of unclaimed funds from a bankruptcy case should check the website of the court where 

the case was filed and use a localized version of the form (or other applications process) from 

that court’s website. More information about unclaimed funds in bankruptcy cases, including a 

link to an unclaimed funds locator subscribed to by most bankruptcy courts, can be found by 

searching for “unclaimed funds” on uscourts.gov. 
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. 

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: _________ District of ______________

(State)

Case number: 

 Fill in this Information to identify the case:
Form 1340 Application for Payment of Unclaimed Funds Page 2 

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

 District of 

[Court enters address here]

6. Applicant Declaration

Pursuant to 28 U.S.C. § 1746, I declare under penalty of 

perjury under the laws of the United States of America that 

the foregoing is true and correct and any fraud in the 

application or supplemental materials may result in criminal 

penalties, see, e.g, 18 U.S.C. § 152.

.

Date: ____________________________

_______________________________________________

Signature of Applicant

_______________________________________________

Printed Name of Applicant

Address:

Telephone: ________________________

Email: _______________________

6. Co-Applicant Declaration (if applicable)

Pursuant to 28 U.S.C. § 1746, I declare under penalty of 

perjury under the laws of the United States of America 

that the foregoing is true and correct and any fraud in the 

application or supplemental materials may result in 

criminal penalties, see, e.g. 18 U.S.C. § 152.

Date: ____________________________

_____________________________________________

Signature of Co-Applicant (if applicable)

_____________________________________________

Printed Name of Co-Applicant (if applicable)

Address:

Telephone: ________________________

Email: _______________________

7. Notarization

STATE OF 

COUNTY OF 

This Application for Unclaimed Funds, dated

 was subscribed and sworn to before 

me this day of , 20 by

who signed above and is personally known to me (or 

proved to me on the basis of satisfactory evidence) to be 

the person whose name is subscribed to the within 

instrument. WITNESS my hand and official seal.

[Notarial wording to be adjusted based on state 

requirements]

(SEAL) Notary Public 

 My commission expires:

7. Notarization

STATE OF 

COUNTY OF 

This Application for Unclaimed Funds, dated

 was subscribed and sworn to before 

me this day of , 20 by

who signed above and is personally known to me (or 

proved to me on the basis of satisfactory evidence) to be 

the person whose name is subscribed to the within 

instrument. WITNESS my hand and official seal.

[Notarial wording to be adjusted based on state 

requirements]

(SEAL) Notary Public 

My commission expires: