Looking for a Vermont Tax Forms And Templates? Download it for free!

Inventory Of Unclaimed Safe Deposit Box Contents Form - Vermont State Treasurer'S Office

Vermont State Treasurer’s Office – Unclaimed Property Division

109 State Street, Montpelier, Vermont 05609-6200

Phone: 802-828-2407 Fax: 802-828-2772

INVENTORY OF UNCLAIMED SAFE DEPOSIT BOX CONTENTS

DO NOT ATTACH TO CONTENTS – ATTACH TO COVER SHEET

1. Holder Name:______________________________________

Rental and Opening

Charges

_______________

2. Branch Where Property Was Held_____________________

_______________

3. Period Covered:________to_______Page________of______

Total __________

4. Safe Deposit Box Number:____________________________

5. Date of Abandonment________________________________

6. Owner Information

Last Name _____________________ First ____________________Middle__________

Mailing Address:__________________________________________________________

___________________________________________________________________________

Social Security Number:_________________________________ __________________

7. Itemized Description of Contents (one Item Per Line or Attach Itemized List)

10.

11.

12.

13.

14.

Inventory Of Unclaimed Safe Deposit Box Contents Form - Vermont State Treasurer'S Office