Instructions For Completing Report Of Unclaimed Property Form

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INSTRUCTIONS FOR COMPLETING
REPORT OF UNCLAIMED PROPERTY
Use the following item-by-item instructions to complete this
COLUMN 6: Enter the name of the bank branch location where
form.
property was held. List the complete address including the zip
code.
WHEN TO REPORT: This form is used to report safe deposit
boxes only. The report page is to be completed and mailed with
COLUMN 7: Enter the various amounts that are still owing to
the Summary Report for Unclaimed Property (REV 80 0004)
the holder. These amounts might include unpaid safe deposit
before November 1 of each year.
box rental charges, drilling fees, safekeeping costs, certified
mailing costs, etc. Do not deduct any of these costs from any
The state will publish the names of the owners of the accepted
cash which may be in the box at this time. Holders will be
safe deposit boxes no later than the following September.
reimbursed for allowed charges and fees by the State following
the Department’s auction of the contents within five years.
WHEN TO REMIT: Do not send safe deposit box contents with
November report. The Department will notify you in writing of its
COLUMN 8: Enter an itemized description of the safe deposit
decision to “accept” or “reject” each of the safe deposit boxes
box or safekeeping contents. Use the following as examples and
reported. Included with your “accept/reject” letter will be a
guidelines in completing your descriptions:
scheduled delivery date and instructions on method of
shipment. All boxes “accepted” are to be sent in their entirety.
a)
one 14K gold color ring w/2 clear stones
All coins and cash must be sent intact. No bank check
b)
three silver color necklaces
substitutions for cash or coin are permitted. Send a copy with
c)
one pair screwback earrings ea. w/one rubylike stone
the “accepted” contents at delivery time. Keep a copy for your
d)
one coin wrapper cont. 50 U.S. Pennies dated 1918-
files.
1964 (if wrapper is empty, be sure to indicate such)
e)
one coin book cont. 73 Jefferson nickels
HOLDER: Enter the holder’s name and address exactly as it
f)
one yellow metal chain w/ivorylike pendant
appears (after corrections, if any) on the Summary Report for
g)
Lucky Strike Mining Co., cert. #LSM634, 50 shs.
Unclaimed Property (REV 80 0004-1).
common, dated 1-13-32
h)
one $50 U.S. Series E savings bond dated 5-12-62,
#Q6349724P
HOLDER NUMBER: Enter the Washington State unclaimed
i)
one env. cont. 2 wills, 4 birth certs., & misc. legal
property holder number assigned to you. Use this number on all
papers
related correspondence.
j)
one env. cont. misc. personal papers of no apparent
value (i.e. receipts, canceled checks, tax papers,
REPORT YEAR: Enter the year for which the report is being
photos, newspaper clippings, etc.)
filed.
Please note: The Department relies on the description
PERIOD COVERED: Enter the period covered that you
provided in this report in making its decision of whether
examined your records for unclaimed property. For example, in
to “accept” or “reject” a particular safe deposit box.
a normal reporting cycle, if a report was filed the previous year,
Descriptions are important, as holders under the
this will be the one year period ending five years before June 30
Unclaimed Property statute will only be relieved of
of this year.
liability for items rejected to the extent of the property
reported.
COLUMN 1: Enter owner’s safe deposit box number or
safekeeping number where contents were held.
COLUMN 9: Do not write in this area. For Department use only.
COLUMN 2: Enter the full name (last name first) of the owner
Upon notification mail the completed copy with your
of the safe deposit box.
“accepted” contents and keep a copy for your files.
a)
List last name, full first name and full middle name,
if available. Be sure to include information which
would aid in identification such as Jr., Sr., Miss,
ADDITIONAL INFORMATION AND FORMS: If you have
Mrs., etc., after the middle name (e.g. Smith, Jane
questions regarding your reporting obligations, please write to
Ann, Mrs.).
the address given below.
b)
Corporate titles and the like should be entered
exactly as adopted except that the word “The” should
Use of this form is required.
be omitted when it is the first word in the title.
c)
List the complete address, including the zip code. If
no address is available, insert “address unknown”.
d)
If a single safe deposit box has two owners, the
names of both must be shown along with the
STATE OF WASHINGTON
relationship (e.g. “trustee for”, “or”, “and”, etc.).
DEPARTMENT OF REVENUE
MISCELLANEOUS TAX DIVISION
COLUMN 3: Enter the owner’s social security number.
UNCLAIMED PROPERTY SECTION
P.O. BOX 448
COLUMN 4: Enter the last known address of the owner of the
OLYMPIA, WASHINGTON 98507
safe deposit box. If a single safe deposit box has two or more

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