Fillable Unclaimed Property Request Form printable pdf download

STATE OF DELAWARE

REQUEST FORM

UNCLAIMED PROPERTY

Fill out the form below as completely as possible. For identification purposes please provide two forms of

identification from the following list. All US citizens must provide a copy of their Social Security or Medicare Card.

Driver’s License

Birth Certificate

Passport

Non-Driver Identification Card

Marriage Certificate

Social Insurance Card

Social Security Card

W-2

National Identity Card

Medicare Card

Election Card

Citizenship Card

If you are inquiring about property not listed in your name, you must provide documentation showing you have a legal

right to claim the property in addition to the information above (EX: Copies of Appointment to Estate, Letters

Testamentary, Small Estate Affidavit, a copy of a notarized Power of Attorney for a living person, verification of court

appointed guardianship, copy of a minor’s birth certificate; etc.) Please note that a power of attorney and related

documents become void after death.

Print your name and address as it would have appeared on the escheated account. (Note: This may be different than

your current address.)

Property Search Information

*Name:

Address:

City:

State:

Zip:

Current Contact Information:

Name:

Mailing Address:

City:

State:

Zip:

Phone #:

Relationship to Property Owner:

SSN or FEIN:

Would you like us to send the claim form via email?____

Email Address (if applicable):

What are you searching for?

Stock

Dividends

Bank acct.

Insurance

General Inquiry

Other_________________

Did you receive any written notice informing you of an escheatment? If so, please attach a copy.

Your Comments:

Under penalties of perjury, I certify that the information provided on this request form is true, and all supporting

documentation presented are either original or true unaltered copies of the original documents. Upon payment of this claim,

said claimant will indemnify and hold harmless the State of Delaware, its Officers and Employees from any damages, claims

or losses of any kind resulting in payment to the claimant under the provisions of Delaware Revised Statutes.

Signature:________________________________________________ Date: _____________________

Once your request is received, a claim form may be sent with additional directions for obtaining your property. If the request

is incomplete or if we are not holding property in your name, you will receive a letter informing you that a claim could not be

initiated. Due to a high volume of requests, it may take up to twelve weeks to receive a response. Your patience is greatly

appreciated.

Upon receipt of your request form, a claim form will be mailed to you at the current mailing address you provide above.

Please complete this form and return it to:

Delaware Division of Revenue, Bureau of Unclaimed Property, P.O. Box 8931, Wilmington, DE 19899

Unclaimed Property Request Form

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