Summary Of Unclaimed Property Form - Kansas Office Of The State Treasurer
Download a blank fillable Summary Of Unclaimed Property Form - Kansas Office Of The State Treasurer in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Summary Of Unclaimed Property Form - Kansas Office Of The State Treasurer with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1 /
State of Kansas
Office of the State Treasurer
Unclaimed Property Division
900 SW Jackson St. Ste 201 • Topeka, KS 66612-1235
Summary of Unclaimed Property
Business Information
Holder Name________________________________________________ Federal Tax ID #_______________________
Business Address_____________________________________________ Company Type ________________________
_______________________________________________
_______
Date Incorporated__________________, In the State of ___________________________________________
Contact Information
Person who supplied information for report
Name______________________________________________________ Title_______________________________
e-mail______________________________________________________
Telephone__________________________
Person/department responsible for responding to property inquiries
Name _____________________________________________________
Title_______________________________
e-mail______________________________________________________
Telephone__________________________
Report Information
Report was submitted by
Paper
Diskette or CD
Using KST Online System
Keep a copy of Diskette or CD and Paper Reports for inquiries
Report Total $____________________________________________
Total properties reported_______________
Payment Method
Check
ACH
Wire
Check, Wire or ACH#____________________________
(Call Lisa: 785-291-3173 for ACH & wire instructions)
Securities Remitted
(enclose confirmation of delivery of share & mutual statments)
Total number of DTC shares remitted (supply verification)
Total number of physical security shares (supply certificates)
Total number of mutual fund shares (supply statement)
Total number of shares remitted
Reporting Safe Deposit Boxes
Yes
No
Number of Safe Deposit Boxes__________________
Attach inventory to Summary of Unclaimed Property form and include copy inside box.
Verification
for the State of_________________________________ County of_______________________________
I, __________________________________, swear that I have prepared, or have caused to be prepared, and have examined this
report as to property presumed abandoned under the Uniform Unclaimed Property Act. I am duly authorized to execute this
verification by the holder and by law. To the best of my knowledge and behalf said report is true, correct and complete. I have
attempted to contact property owners at their last known address by first-class mail if the property is a Safe Deposit Box,
Stock or over $100.00. I am duly authorized to attest to this.
Signature_______________________________ Title__________________Date___________
Seal
Subscribed and sworn before me on this _________Day of_______________________________
Notary Public_____________________________ My commission Expires__________________
12
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal