Fillable Business Affidavit Template 2013 printable pdf download

Business Affidavit Template 2013

Download a blank fillable Business Affidavit Template 2013 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 Business Affidavit Template 2013 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.

WARNING:

To protect against the possibility of others accessing your confidential

information, do not complete these forms on a public workstation.

Department of Revenue

Unclaimed Property Section

Reset This Form

Business Affidavit

RE: Unclaimed Property Account Number: ______________________________________________________

The total amount is approximately: $ _______________________________________________________

I, _________________________________________________, hereby affirm that I am employed by or am an

(Print or Type Name)

officer of __________________________________________ and am duly authorized to claim such funds as

may be held by you.

In the event a superior claim is received and honored by the Department of Revenue, I will hold harmless the

payer of the claim, and will return such funds as received under this claim.

____________________________________

(Signature)

(Title Held)

Subscribed and sworn to before me this _________ day of __________________

_________________

(Year)

(Day)

(Month)

________________________________________

(Notary’s Signature)

Notary in and for the state of _________________

Print This Form

My commission expires _____________________

If the owner is a business/agency/institution:

Mail all affidavit(s) with the signed

1. Copy this form onto your company’s letterhead. If your

and dated claim form(s) to:

company does not have letterhead, complete the affidavit

State of Washington

and attach a copy of your business license or other documentation

Department of Revenue

identifying your business as a legal entity.

Unclaimed Property Section

2. Complete the form.

PO Box 47477

3. Have your signature notarized.

Olympia, WA 98504-7477

4. Return the affidavit with your competed claim form to our office.

- OR -

Multiple claims? Use one affidavit for all and list the total number of claims and dollar amount.

Note: if the business is closed do not use the Business Affidavit, instead provide a copy of a IRS Schedule K-1 which

lists the shareholders and their ownership.

For tax assistance visit please call 1-800-435-2429. To inquire about the availability of this document in an alternate format, please call 1-800-647-7706.

Teletype (TTY) users may use the Washington Relay Service by calling 711.

REV 80 0034 (8/29/13)

Business Affidavit Template 2013

Related Articles

Related forms

Related Categories