Unclaimed Property Claim Form Request printable pdf download

Unclaimed Property Claim Form Request

Kentucky State Treasury

Unclaimed Property Claim Form Request

Note: This is NOT a claim form. Submit this form to receive an official claim form.

Todd Hollenbach, State Treasurer

Owner name: _____________________________________ Property ID number: _________________

Owner date of birth: ________________________

Name of person requesting claim form: ___________________________________________________

Relationship to owner: ________________________________________________________________

(for example: spouse, executor/administrator, parent, heir, etc.)

Address: ___________________________________________________________________________

___________________________________________________________________________

Daytime phone #: (_____) _____-________ E-mail address: ________________________________

Please give the last 4 digits of the reported owner’s Social Security number or FEIN, if a business:

__________

Please answer the questions below to assist us in verifying information on our database to assure that

you are entitled to claim these funds. Please circle the correct response(s).

1. Did the reported owner ever live or receive mail at the address

Yes

shown on the search page?

2. Is the reported owner deceased?

Yes

If yes, date: ____________

3. Name of the administrator/executor of the reported owner's

estate?___________________________________________

NOTE: If the owner has never lived or received mail at the address reported – and cannot provide the

required documentation – eligibility to claim cannot be established.

Please mail this form to:

Unclaimed Property Division · 1050 US 127 South, Suite 100 · Frankfort, KY 40601

(800) 465-4722

Unclaimed Property Claim Form Request