Cot/st 918 - Maryland Unclaimed Property Report Template
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Unclaimed Property Unit
301 W. Preston St
Room 310
Baltimore, MD 21201-2385
MARYLAND UNCLAIMED PROPERTY REPORT
HOLDER NUMBER:
H OL DE R :
FOR THE YEAR ENDED:
DUE DATE:
A. If you have NO unclaimed property to report for this period, check here:
_____
B. If you DO have unclaimed property to report:
1. Enter total $ amount of all accounts LESS than $100.00 here.
$____________
2. Use FORM COT/ST 919 to report:
•
Individual accounts $100.00 and GREATER
Securities (stocks, bonds, certificates, etc.)
•
•
Safe Deposit Boxes
Enter total number of unclaimed accounts $100.00 and GREATER
listed on FORM COT/ST 919 here. _____________
IMPORTANT: We will notify owners to call you about this report at
unless you give a preferred telephone number here.
I declare under penalties of perjury that this report (including any accompanying schedules and statements)
has been examined by me and to the best of my knowledge is a true and complete report.
__________________________
________________________
___________________
Signature
Title
Date
Federal I.D. No. _____________________
Name of Company or Corporation: ___________________________________
Mailing Address: __________________________________________________
Location Address: _________________________________________________
City & State: ___________________________________Zip________________
Contact Person: ___________________________________________________
Telephone Number for Contact Person: _______________________________
COT/ST 918 Rev. 02/03
(410) 767-1700 OR Toll Free 1 (800) 782-7383 Outside of the Baltimore Area
Fax: (410)333-7150
Cot/ST 918
Rev. 2/03
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