Form Ap De-1 - Ics 215-Os

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DISCLOSURE AND NOTICE OF INTENT TO CONVERT
UNCLAIMED PROPERTY EXAMINATION INTO A REVIEW UNDER
THE SECRETARY OF STATE’S UNCLAIMED PROPERTY VOLUNTARY
DISCLOSURE AGREEMENT PROGRAM PURSUANT TO 12 Del. C. § 1172(b)
COMES NOW _____________________________________________________________________,
its subsidiaries and related entities (“Holder”), acting by its duly authorized officer.
WHEREAS, on _______, the Holder received a Notice of Examination from the Delaware Department of
Finance commencing a review of the Holder’s books and records to determine the compliance of the Holder
and its subsidiaries and related entities with the Delaware Abandoned and Unclaimed Property Law,
Chapter 11 of Title 12 of the Delaware Code (the “Examination”);
WHEREAS, the Examination has not been completed, and the Holder is coming forward in good faith to
voluntarily comply with the Abandoned or Unclaimed Property Law;
WHEREAS, the State of Delaware (the “State”) desires to induce the Holder's compliance with the
Abandoned or Unclaimed Property Law;
WHEREAS, pursuant to 12 Del. C. §1172(b), Holder is eligible to convert the Examination into a review
under the Secretary of State’s Voluntary Disclosure Agreement Program (the “Program”), and must notify
the State Escheator and Secretary of State of the Holder’s intent to do so; and
WHEREAS, this form shall constitute the proper form for Holder to make the disclosure and notice of
intent to convert the Examination pursuant to 12 Del. C. §1172(b).
NOW THEREFORE, in consideration of the mutual promises hereinafter set forth, the parties agree as
follows:
The Holder shall complete a review of its books and records and file reports for all abandoned or unclaimed
property related to the period that is 10 years prior to when property is presumed abandoned or unclaimed
under this chapter from the calendar year in which the State Escheator provided the original notice of
examination.
The Holder understands and agrees that the hold notice contained within the Notice of Examination issued
to the Holder by the Delaware Department of Finance remains in effect. Holder will ensure that all records
including, but not limited to bank statements, bank reconciliations, outstanding check lists, detail general
ledgers, aged accounts receivable reports, and if applicable, information surrounding gift certificate/card
issuances and redemptions, etc. will be retained, despite any record retention policies to the contrary, until
the Voluntary Disclosure Agreement is completed and accepted by the Secretary of State.
The State agrees that, upon its satisfactory review and approval of the reports and materials submitted by
the Holder, and upon payment of the abandoned property to the State or the establishment of a payment
plan by the Holder that is accepted by the State, the Secretary of State will enter into its form Voluntary
Disclosure Agreement with the Holder, granting the Holder the protections contemplated by that agreement.
The Holder agrees to enter into a Voluntary Disclosure Agreement with the Secretary of State, subject to
the provisions of Section 1173 of Title 12 of the Delaware Code, and to either pay the abandoned or
unclaimed property due to the State under the Abandoned and Unclaimed Property Law, or enter into a plan
for its payment, no later than the two year anniversary of the effective date of this Agreement. If the Holder

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