Inventory Report Form - State Of Vermont printable pdf download

Inventory Report Form - State Of Vermont

Vermont State Treasurer’s Office – Unclaimed Property Division

109 State Street, Montpelier, Vermont 05609-6200

Phone: 802-828-2407 Fax: 802-828-2884

INVENTORY REPORT

UNCLAIMED SAFE DEPOSIT CONTENTS

IMPORTANT NOTE:

DO NOT ATTACH REPORT TO BOX CONTENTS

ATTACH TO COVER SHEET

1. Holder Name: ____________________________________________

Rental and Opening

Charges

2. Branch Property Held:_____________________________________

________________

3. Period Covered: __________to _________Page _______ of _______

___________________

4. Safe Deposit Box Number:__________________________________

Total ____________

5. Date of Abandonment:________________ Date Drilled: ______________

6. Owner(s) Information:

Last Name _______________________First _________________ M ____ SS # _____________

Mailing Address: _______________________________________________________________

Last Name _______________________First _________________ M ____ SS # _____________

Mailing Address: _______________________________________________________________

7. List Codes and Itemized Description of Contents (one Item Per Line or Attach Itemized List)

CODE

QUANITY

CONTENTS DESCRIPTION

Inventory Report Form - State Of Vermont