Form 2a - Detail Sheet Annual Unclaimed Property Report - 2001 Page 2
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2STATE OF OREGON
FORM 2A
DEPARTMENT OF STATE LANDS
DETAIL SHEET
ANNUAL UNCLAIMED PROPERTY REPORT ______________________________________ File No. ____________
(NAME OF HOLDER)
(DO NOT USE)
DATE OF LAST
TRANSACTION OR
DATE PROPERTY
PROPERTY
OWNER’S LAST NAME, FIRST NAME,
BECAME PAYABLE,
DESCRIPTION:
STREET ADDRESS,
REDEEMABLE, OR
CITY, STATE, ZIP
OWNER
NUMBER OF
SAVING, CHECKING,
RETURNABLE
SOCIAL SECURITY
SHARES
DIVIDEND, PAYROLL,
IDENTIFYING
COUNTY (if known)
ETC.
NUMBER
AMOUNT REMITTED
NUMBER
DUE OWNER
(3)
(1)
(2)
(4)
(5)
(6)
(7)
PAGE TOTAL
PAGE TOTAL
GRAND TOTAL
==================
GRAND TOTAL
===============
FM 81 2A 2001
2A
(IF THIS IS THE LAST PAGE OF THE REPORT, ENTER GRAND TOTAL)
ATTACH TO FORM 1A
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