Form 3a - Detail Sheet Of Safe Deposit Box Contents Annual Unclaimed Property Report

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STATE OF OREGON
ANNUAL REPORT OF PROPERTY PRESUMED ABANDONED
INSTRUCTIONS FOR FORM 3A
SAFE DEPOSIT CONTENTS DETAIL SHEET
• Contents are due January 1 through January 30 unless prior approval has been granted for
early remittance. Please do not send contents prior to January 1. (Note: Reports are due
between October 1 and November 1).
PLEASE TYPE OF PRINT LEGIBLY
Column (1): List the safe deposit box number. If the number assigned to the account is through
safekeeping, please use "SFK".
Column (2): List the last activity date (when the customer last opened the box). If this date is
unknown, list the date the box was drilled.
Column (3): List the full name and address of the owner(s) of record and anyone who had authority
to access the box. Specify if individual or joint ownership, and any other information that would help
determine ownership. When possible, list alphabetically by last name. If stocks or bonds are found in
the box, list the box holder's name, not the owner of the securities.
Column (4): List the owner's social security or federal ID number.
Column (5): If there are unpaid rent or drilling charges owing to the bank, Oregon will attempt to
assist you in recovering them. To do so, you must list the total of these charges in this column. If a
claim is filed, the claimant will be required to obtain a receipt or waiver from the bank for the charges.
Column (6): List the inventory of contents being reported. If you have a LEGIBLE copy of the
inventory taken when the box was drilled, you may attach it to Form 3A.
Attach Form 3A to the Summary Sheet Form 1A, and follow the instructions below:
1
The original report must be mailed in a separate envelope to the Reports Coordinator by
November 1st. A copy of the report must be placed in the package containing the contents.
2.
Mail contents in January, by certified mail, return receipt requested. Please label the packages
“To Be Delivered Unopened”. Include in each package a packing slip that identifies the
individual owners’ boxes inside the package. Ship to: Dept of State Lands, 775 Summer St NE
Ste 100, Salem, OR 97301-1279
3.
The outside of each package must be clearly marked with the name and address of the bank,
the branch (if applicable), name and phone number of the contact person.
4.
The contents of the safe deposit box must be sent intact. Please do not deposit any cash or
coins. If you have any questions, please call the reports coordinator @ 503-986-5290.
INTERNET AND EMAIL ADDRESSES FOR INFORMATION, FORMS, STATUTE, OR RULES:
Internet:
Email:
holder@dsl.state.or.us

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