AC 2686 (1/02) STATE OF NEW YORK – OFFICE OF THE STATE COMPTROLLER – REPORT OF ABANDONED PROPERTY
AC 2686 (1/02) STATE OF NEW YORK – OFFICE OF THE STATE COMPTROLLER – REPORT OF ABANDONED PROPERTY
Page _______ of _______
Page _______ of _______
Do Not Write in This Area Rec Name of Reporting Organization
Do Not Write in This Area Rec Name of Reporting Organization
Address of Reporting Organization
Address of Reporting Organization
City
City
State
State
Zip
Zip
For The Period Ending
For The Period Ending
OUF USE ONLY
OUF USE ONLY
No.
No.
, 20
, 20
Owner Last Name (20)
First Name (10)
M.I.
Suffix (3)
Account Title (70)
1
Owner Address 1 (30)
Owner Address 2 (30)
Owner City (20)
State (2)
Zip (9)
Country if Not USA
Lot No.
Soc. Sec. No./Empl. ID No.
Property Type (2)
Property ID Number (20)
Date (MMDDYY)
Initial Amount
Escheated Amount
Removal Indicator (If Applicable, Enter “P” or “R”)
Multiple Owners
P
Otherwise
R
Reg.
$
$
Owner Claimed
Reduced to Zero
Yes
Description of Security (70)
CUSIP Number of Security
No. of Shares or Denomination Method of Transfer
Owner Last Name (20)
First Name (10)
M.I.
Suffix (3)
Account Title (70)
2
Owner Address 1 (30)
Owner Address 2 (30)
Owner City (20)
State (2)
Zip (9)
Country if Not USA
Lot No.
Soc. Sec. No./Empl. ID No.
Property Type (2)
Property ID Number (20)
Date (MMDDYY)
Initial Amount
Escheated Amount
Removal Indicator (If Applicable, Enter “P” or “R”)
Multiple Owners
P
Otherwise
R
Reg.
$
$
Owner Claimed
Reduced to Zero
Yes
Description of Security (70)
CUSIP Number of Security
No. of Shares or Denomination Method of Transfer
Owner Last Name (20)
First Name (10)
M.I.
Suffix (3)
Account Title (70)
3
Owner Address 1 (30)
Owner Address 2 (30)
Owner City (20)
State (2)
Zip (9)
Country if Not USA
Lot No.
Soc. Sec. No./Empl. ID No.
Property Type (2)
Property ID Number (20)
Date (MMDDYY)
Initial Amount
Escheated Amount
Removal Indicator (If Applicable, Enter “P” or “R” )
Multiple Owners
P
Otherwise
R
Reg.
$
$
Owner Claimed
Reduced to Zero
Yes
Description of Security (70)
CUSIP Number of Security
No. of Shares or Denomination Method of Transfer
Owner Last Name (20)
First Name (10)
M.I.
Suffix (3)
Account Title (70)
4
Owner Address 1 (30)
Owner Address 2 (30)
Owner City (20)
State (2)
Zip (9)
Country if Not USA
Lot No.
Soc. Sec. No./Empl. ID No.
Property Type (2)
Property ID Number (20)
Date (MMDDYY)
Initial Amount
Escheated Amount
Removal Indicator (If Applicable, Enter “P” or “R”)
Multiple Owners
P
Otherwise
R
Reg.
$
$
Owner Claimed
Reduced to Zero
Yes
Description of Security (70)
CUSIP Number of Security
No. of Shares or Denomination Method of Transfer
Owner Last Name (20)
First Name (10)
M.I.
Suffix (3)
Account Title (70)
5
Owner Address 1 (30)
Owner Address 2 (30)
Owner City (20)
State (2)
Zip (9)
Country if Not USA
Lot No.
Soc. Sec. No./Empl. ID No.
Property Type (2)
Property ID Number (20)
Date (MMDDYY)
Initial Amount
Escheated Amount
Removal Indicator (If Applicable, Enter “P” or “R”)
Multiple Owners
P
Otherwise
R
Reg.
$
$
Owner Claimed
Reduced to Zero
Yes
Description of Security (70)
CUSIP Number of Security
No. of Shares or Denomination Method of Transfer