Form 53-118 - Payment For Unclaimed Property printable pdf download

Form 53-118 - Payment For Unclaimed Property

53-118

(8-02)

PAYMENT FOR UNCLAIMED PROPERTY

Complete one copy for each check submitted.

Detach and mail the form below along with your payment(s) to:

TEXAS STATE COMPTROLLER OF PUBLIC ACCOUNTS

Unclaimed Property Division

P.O. Box 12019

Austin, TX 78711-2019

For assistance, call 1-800-321-2274, extension 6-6246, toll free nationwide, or in Austin, call (512)936-6246.

DETACH AND SEND ONLY THE COPY BELOW TO THE COMPTROLLER'S OFFICE

53-118

(8-02)

PAYMENT FOR UNCLAIMED PROPERTY

Complete one copy for each check submitted.

Shaded areas for Comptroller use only.

9 0 1 0 0

PAYMENT

1. T code ....................................................................... 1.

UNCLAIMED PROPERTY DEPOSIT CODES

551 - Accruing stock dividends

553 - Ongoing mineral production

5 5

3. Deposit code ............................................................. 3.

552 - Annual holder report

556 - Interest and penalty

4. Federal Employer's Identification Number (FEIN) ..... 4.

5. Amount of check (Dollars and cents) ........................ 5.

Holder name

Postmark date

Form 53-118 - Payment For Unclaimed Property