Waiver Request Form printable pdf download

Waiver Request Form

ALAN G. HEVESI

110 STATE STREET

COMPTROLLER

ALBANY, NEW YORK 12236

STATE OF NEW YORK

OFFICE OF THE STATE COMPTROLLER

OFFICE OF UNCLAIMED FUNDS

WAIVER REQUEST

We respectfully request a waiver from completing publication activities relative to our abandoned property filing, as

described in Section 1411 of the Abandoned Property Law.

Reporting Organization Name:

Contact Name:

Title:

Telephone Number:

Fax:

Date of Request:

Signature:

Please attach any cost estimates you may have obtained to this request. If estimates are not provided with this

form, it will be returned for insufficient information.

Note:

*Any request for a waiver should be received in our office at least 30 days prior to the event due date.

*Waivers for any other requirements or components of the reporting process cannot be granted. The New

York State Abandoned Property Law only grants authority to waive publications.

RESERVED FOR USE OF STATE COMPTROLLER

In evaluating this request, we considered, among other things, timeliness of the request, previous filing history,

previous waiver requests, and cost estimate analysis.

WAIVER APPROVED

WAIVER DENIED

ACTIVITY DUE DATE

Approved/Denied by:

Please direct any questions relative to this process to NYSRPU at

nysrpu@osc.state.ny.us

Waiver Request Form