Unclaimed Property Original Owner Claim Form - City Of Round Rock Finance Department
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1City of Round Rock
Mail to: City of Round Rock
Unclaimed Property
Finance Department
Original Owner Claim Form
Unclaimed Property
221 East Main Street
Round Rock, TX
78664
Claimant Information (Claimant must be 18 or older to claim property)
Name of Claimant
First
Middle
Last
Current Mailing Address
PO Box, Street, Etc.
Building, Suite, Apartment Number
City
State
Zip Code
Current Street Address (if different)
PO Box, Street, Etc.
Building, Suite, Apartment Number
City
State
Zip Code
Daytime phone number
Other Phone
(In Case we need to contact you in regards to your claim)
Identifying Information
This information is necessary to validate proof of ownership of the property and will remain confidential
Driver's License Number
Issuing State
Social Security Number
Previous Address
Attachments
The following documents must be sent along with this claim form for the claim to be considered complete and valid
A) Proof of Claimant's Social Security Number
B) Copy of Claimant's Driver's License or any Official form used for indentification
C) Proof of previous address (Copy of utility bill, canceled check, etc.)
Claimant Signature
The named Claimant hereby certifies that this claim for property presumed abondoned is valid and just, that all statements herein are true and correct,
and that upon payment of this claim said Claimant will indemnify and hold harmless the City of Round Rock, and it' s officers and employees for any
damages, claims or losses of any kind resulting from the payment of the above described property to the Claimant.
Claimant
Date
Co-Owner
Date
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Parent category: Financial