Report Form 1 - Unclaimed Property Division - Alabama Department Of Treasury Page 3
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3REPORT FORM 3
This form must be completed and filed with Report Form 1 when reporting safe deposit box contents.
K
I
, S
T
AY
VEY
TATE
REASURER
U
P
D
___________________________________________________________________________________________
Page ________ of ________
NCLAIMED
ROPERTY
IVISION
NAME OF BUSINESS
P. O. Box 302520 • Montgomery, AL 36130-2520 • (334) 242-9614
1-888-844-8400
_________________________________________________________________________________________________________________________
MAILING ADDRESS
CITY
STATE
ZIP CODE
Safe Deposit Box Contents
Federal ID
_______________________________ Report Year ____________ Period Covered ____________________ to ___________________
ONE OWNER PER PAGE
MONTH, DAY, YEAR
MONTH, DAY, YEAR
OWNER’S NAME (LAST, FIRST, MIDDLE)
OWNER’S SOCIAL SECURITY NUMBER
BRANCH NAME, CITY & STATE
SAFE DEPOSIT BOX NUMBER
WHERE PROPERTY WAS HELD
CO-OWNER’S NAME (LAST, FIRST, MIDDLE)
CO-OWNER’S SOCIAL SECURITY NUMBER
DATE OF ABANDONMENT (MO., DAY, YR.)
OWNER’S MAILING ADDRESS
DATE DRILLED9 (MO., DAY, YR.)
TREASURER’S
TREASURER’S
QUANTITY
DESCRIPTION OF CONTENTS
QUANTITY
DESCRIPTION OF CONTENTS
USE
USE
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Inventoried By:
Name: _______________________________________ Signature: ________________________________________Date: ______________________
Name: _______________________________________ Signature: ________________________________________Date: ______________________
This form may be duplicated for additional owners
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