Form 3a - Detail Sheet Of Safe Deposit Box Contents Annual Unclaimed Property Report Page 2
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1
2Form 3A
State of Oregon
Detail Sheet of Safe Deposit Box Contents
________________________________________
File No. _________________________
Dept of State Lands
Annual Unclaimed Property Report
(Name of Holder)
(DO NOT USE)
Safe
Owner’s Last Name, First
Deposit
Name, Street Address,
Charges
For State Use Only
Box
City, State Zip County (if
Owner Social
Owing
Number
Last Activity
known) (List Alphabetically by
Security
Bank
Inventory of Contents
Actual
Master
(1)
Date (2)
Last Name) (3)
Number (4)
(5)
(6)
Value
No.
FOR STATE USE ONLY
FOR STATE USE ONLY
Total
Checked by
_____________________________________
(If this is the last page of
________ ________
_______
Date
report, enter grand total
__________________________________
here)
FM 81 3A 2001
Attach to Form 1A
3A
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Parent category: Financial