Form Up-2 - Unclaimed Property Report - Owner Information
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1State of New Jersey
UP-2 (5-97)
DIVISION OF TAXATION
PROPERTY ADMINISTRATION
UNCLAIMED PROPERTY REPORT - OWNER INFORMATION
(Omit all punctuation)
Page ______ of ______
For Period Ended
__________________________________________________________________
________________ 20____
HOLDER
REC
OWNER LAST NAME
FIRST NAME
M.I. SUFFIX
OWNER ID/SS#
NO. OF OWNERS
OWNERSHIP TITLE
NO.
OWNER ADDRESS STREET 1
OWNER ADDRESS STREET 2
CITY
STATE
ZIP
COUNTRY
(IF NOT U.S.)
PROPERTY CODE
PROPERTY ID NUMBER
DATE (MM DD YY)
CASH REPORTED
SECURITIES
TRANSFER
CUSIP #
REPORTED
METHOD
$
OWNER CERTIFICATE ID NO.
DATED DATE OF
DESCRIPTION OF PROPERTY / ISSUE NAME
REMITTED SECURITIES
CASH DIVIDEND(s)
From:
To:
REC
NO.
OWNER LAST NAME
FIRST NAME
M.I. SUFFIX
OWNER ID/SS#
NO. OF OWNERS
OWNERSHIP TITLE
OWNER ADDRESS STREET 1
OWNER ADDRESS STREET 2
CITY
STATE
ZIP
COUNTRY
(IF NOT U.S.)
PROPERTY CODE
PROPERTY ID NUMBER
DATE (MM DD YY)
CASH REPORTED
SECURITIES
TRANSFER
CUSIP #
REPORTED
METHOD
$
OWNER CERTIFICATE ID NO.
DATED DATE OF
DESCRIPTION OF PROPERTY / ISSUE NAME
REMITTED SECURITIES
CASH DIVIDEND(s)
From:
To:
REC
NO.
OWNER LAST NAME
FIRST NAME
M.I. SUFFIX
OWNER ID/SS#
NO. OF OWNERS
OWNERSHIP TITLE
OWNER ADDRESS STREET 1
OWNER ADDRESS STREET 2
CITY
STATE
ZIP
COUNTRY
(IF NOT U.S.)
PROPERTY CODE
PROPERTY ID NUMBER
DATE (MM DD YY)
CASH REPORTED
SECURITIES
TRANSFER
CUSIP #
REPORTED
METHOD
$
OWNER CERTIFICATE ID NO.
DATED DATE OF
DESCRIPTION OF PROPERTY / ISSUE NAME
REMITTED SECURITIES
CASH DIVIDEND(s)
From:
To:
REC
NO.
OWNER LAST NAME
FIRST NAME
M.I. SUFFIX
OWNER ID/SS#
NO. OF OWNERS
OWNERSHIP TITLE
OWNER ADDRESS STREET 1
OWNER ADDRESS STREET 2
CITY
STATE
ZIP
COUNTRY
(IF NOT U.S.)
PROPERTY CODE
PROPERTY ID NUMBER
DATE (MM DD YY)
CASH REPORTED
SECURITIES
TRANSFER
CUSIP #
REPORTED
METHOD
$
OWNER CERTIFICATE ID NO.
DATED DATE OF
DESCRIPTION OF PROPERTY / ISSUE NAME
REMITTED SECURITIES
CASH DIVIDEND(s)
From:
To:
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