Form Up-2k - Detail Reporting - Safekeeping - 2010
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1UP-2K (Rev. 06/2010)
GEORGIA DEPARTMENT OF REVENUE
UNCLAIMED PROPERTY PROGRAM
DETAIL REPORTING FORM UP2K - SAFEKEEPING
2010
When reporting 25 or more properties, a NAUPA formatted CD is required
.
Report Date ________________
Federal Employee ID No.
Business Name
Page _______of _______
Ga. Holder No.
RELATIONSHIP
DATE
BETWEEN
S.S. # /
OF
OWNERS
SAFE DEPOSIT BOX OR
OWNER’S NAME AND LAST KNOWN ADDRESS
BIRTH
TAX ID NO.
INDENTIFYING NUMBER
(IF APPLICABLE)
DATE DRILLED
(1)
(4)
(5)
(2)
(3)
(6)
(7) TOTAL SAFEKEEPING ITEMS REPORTED THIS PAGE
(8) GRAND TOTAL SAFEKEEPING ITEMS FOR REPORT
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Parent category: Financial