MONTANA
UCM-1
Clear Form
Rev. 06-08
Report of Property Presumed Unclaimed
Trust for Unlocatable Mineral Owners
Name of Holder ___________________________
Name of Contact __________________________
Address _________________________________
Address _________________________________
Address _________________________________
Address _________________________________
City, ST, Zip ______________________________
City, ST, Zip ______________________________
Phone _____________ E-Mail _______________
Phone _____________ E-Mail _______________
1. FEIN:
Extension No.:
2. Account ID:
3. Report Year:
4. Report No._________. Your original report
is considered Report No. 1. Please see
5. If you are no longer in business and want your
instructions.
account cancelled, check here.
Enter fi nal date._______________________
6. If your address has changed, check here.
Section I:
If you are reporting property other than unclaimed mineral property, you are required to use
Form UCH-1, Report of Property Presumed Unclaimed.
Total number of mineral properties being reported _______________
Amount remitted $ _____________
The amount remitted is for all items held and owing that have remained unclaimed, unpaid and are presumed
abandoned/unclaimed. The amount remitted is the total from Section II, page 2. Please remit only one check
and make it payable to Montana Department of Revenue.
I, the undersigned, declare under penalty of perjury, that to the best of my knowledge and belief, the following
is a true and complete report of unclaimed property now in possession or under control of the holder, which is
presumed unclaimed in accordance with Montana law, 70-9-801 through 70-9-829, MCA. Written notice has
been sent to the apparent owner as prescribed under Montana law, 70-9-808(5), MCA.
Name of Offi cer or Holder Authorized to Sign Report (please print) __________________________________
Signature ______________________________________________________ Date ____________________
Title __________________________________ Phone __________________ Fax _____________________
Mail this report and remittance to:
Unclaimed Property, Montana Department of Revenue, PO Box 5805, Helena MT 59604-5805
Questions? Call toll free (866) 859-2254 (in Helena 444-6900).
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