Kansas Individual Safe Deposit Box Inventory Form

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Kansas

individual safe deposit box inventory

Bank Name_____________________________________ Contact Name________________________________ Phone_______________________

Name

box information

Box Number _______________________________ Branch Name ______________________________________________________ Abandonment Date _______________

Name

Do not remove money from the contents to pay bank fees. If money is recovered we

Drill Fee _____________ Rent Fee ________________ Total Due Bank _______________

will reimburse your fees at a later date.

owner information

Renter 1 __________________________________________ ___________________ Renter 3 ____________________________________________ __________________

SSN

Name

SSN

Renter 2 __________________________________________ ___________________ Renter 4 ____________________________________________ __________________

SSN

Name

SSN

Last Known Address_______________________________________________________ City_______________________________ State_________ Zip_________________

Relationship Code (from page 9) Our office uses this code to determine how to pay claims. If left blank, we will assume OR and any Renter above can claim the contents.

The bottom of this form needs to be completed if your bank DOES NOT have its own itemized inventory form. If you have an itemized

inventory form, attach it to this sheet and only fill out the Box information and Owner information above.

Documents in Box (check all that apply)

5 Misc Vital Statistics

5 Misc Legal

5 US Savings Bonds - Total Number_______

(Birth, Death Marriage)

(Will, Divorce, Adoption)

5 Misc Media and/or Photos

5 Misc Military

5 Stock Certificates - Total Number_______

(Disks, CD’s, Negatives)