Compliance Assistance Program Commitment Form
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1Compliance Assistance Program Commitment Form
Company Name:
__________________________________________
Address:
__________________________________________
__________________________________________
City_______________ State_______ Zip_________
FEIN/Social Security #:
__________________________________________
State of Incorporation:
__________________________________________
Date of Incorporation:
__________________________________________
Authorized Representative:
__________________________________________
Telephone:
__________________ Fax: ____________________
E-Mail Address:
__________________________________________
Date:
__________________________________________
The purpose of this commitment form is to express the intent of __________________________ (the
Company) to properly report and remit all unclaimed property due to the state for the years covered by the
look back period and to develop procedures to ensure future compliance. The look back period (the time
for which the holder is expected to review and report unclaimed property) for this program is a maximum
of ten (10) years. The Company will fully comply with O.S. Title 60, Chapter 13 - Oklahoma Unclaimed
Property Statues and Chapter 80 - Oklahoma Unclaimed Property Administrative Rules by the agreed
upon commitment date on this form. In return, the State Treasurer shall waive the assessment of the
following penalties and interest according to O.S. 60 Section 680 for those years covered by the look back
period:
•
Failure to report/remit - 10% interest of the property value
•
Willful failure to report or deliver - Civil penalty $100 per day ($5,000 maximum)
•
Willful failure to pay or deliver - penalty 25% of the property value
Upon receipt of the completed commitment form signed by an authorized representative of the Company,
the State Treasurer will expect the Company to begin to develop necessary procedures to achieve
compliance with the Oklahoma Unclaimed Property statutes, including proper remittance and reporting of
all unclaimed property due to the state for the years covered by the look back period. If compliance is
achieved by the commitment date, no penalties and interest will be assessed by the Treasurer. Failure to
comply with the terms of the Compliance Assistance Program Commitment Form by the agreed upon
commitment date will result in the dismissal of the State Treasurer’s willingness to waive the assessment
of penalties and interest. It should be understood that this signed Compliance Assistance Program
Commitment Form does not relinquish the Oklahoma State Treasurer’s right to audit the Company.
Information related to filing unclaimed property can be obtained at
The Oklahoma State Treasurer’s Unclaimed Property Division can be reached at (405) 521-4275 if you
have questions. Please sign and date the form.
Return to:
Oklahoma State Treasurer
Unclaimed Property Division
4545 N. Lincoln Blvd., Suite 106
Oklahoma City, OK 73105-3413
Commitment Date (not to exceed one (1) year from the date of form) ______________________
Reporting Years Included in Commitment _______________________________________
Company Authorized Representative _______________________________________
Date:
_______________________________________
State Treasurer Authorized Representative _______________________________________
Date:
_______________________________________
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