Form Tr-0412 - Self-Examination Questionnaire
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STATE OF TENNESSEE TREASURY DEPARTMENT
UNCLAIMED PROPERTY DIVISION
P.O. Box 198649 Nashville, Tennessee 37219-8649 (615) 253-5362
Email: ucp.holders@state.tn.us
SELF-EXAMINATION QUESTIONNAIRE
Please use this tool to review your operations.
Please retain a copy for your records and mail the original to the address above.
Company ________________________________
Incorporation Date ______________________
Phone Number___________________________
Email Address __________________________
State of Incorporation _____________________
Headquarter State ______________________
Representative ___________________________
Date ___________________________________
Audit Contact ____________________________
Title ___________________________________
Affiliated Company ______________________
Affiliated Company _____________________
FEIN _______________________________
FEIN _____________________________
Incorporation Date __________________
Incorporation Date _________________
Included in Report
Yes
No
Included in Report
Yes
No
Please attach affiliate list.
RECORD RETENTION PERIODS
Number of Years
Retention Format
1. General Ledgers
________________
________________
2. Journals
________________
________________
3. General Journal Entries
________________
________________
4. Bank Reconciliations
________________
________________
POLICIES OR PROCEDURES RELATING TO UNCLAIMED PROPERTY
1. Does the company have any written policies or procedures which relate to unclaimed
property?
Yes
No
2. Is the company relying on an opinion from legal counsel for reporting unclaimed property?
Yes
No
3. Where is the unclaimed property function assigned in your enterprise?
__________________________________________________________________________________
__________________________________________________________________________________
TR-0412
(1)
RDA 2128
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Parent category: Financial