Form Ap-1 Ins - Report Of Unclaimed Property Page 2
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2FORM AP-1 INS
REV 8/2014
CHECKLIST OF PROPERTY REPORTED
YES
NO
ACCOUNT BALANCES (3 years inactive)
YES
NO
TRUST, EQUITY AND
DEBT ACCOUNTS (3 years inactive)
_____ _____ A. Checking accounts
_____ _____
A. Paying agent accounts
_____ _____ B. Savings accounts
_____ _____
B. Unclaimed dividends (portfolio)
_____ _____ C. Matured certificates of deposit
_____ _____
C. Funds held in a fiduciary capacity
or savings certificates
_____ _____ D. Christmas Club accounts
D. Funds paid toward the purchase of
_____ _____
shares, or interest in a financial or
business organization
_____ _____ E. Money on deposit to secure funds
E. Funds received for redemption of
_____ _____
stocks and bonds
_____ _____ F. Security deposits
_____ _____
F. Stocks (underlying and undeliverable)
_____ _____ G. Unidentified deposits
G. Bonds (matured bond principal)
_____ _____
_____ _____ H. Suspense accounts
_____ _____
H. Any other certificates of ownership
_____ _____ I. Any sum owing to a shareholder,
_____ _____
I. Suspense liabilities
certificate holder, member, bond
holder or other security holder, or
participating member of a cooperative,
YES
NO
OFFICIAL CHECKS (3 years inactive)
such as:
_____ _____
1. dividends (underlying and undeliverable)
_____ _____
A. Certified checks
_____ _____
2. interest
B. Cashier’s checks
_____ _____
_____ _____
3. principal payments
_____ _____
C. Registered checks
_____ _____
4. equity payments
_____ _____
D. Treasurer’s checks
_____ _____
5. profits
E. Drafts
_____ _____
_____ _____
6. other distributions
_____ _____
F. Warrants
_____ _____ J. Escrow Funds
G. Money orders
_____ _____
H. Travelers checks (15 years inactive)
_____ _____
_____ _____
I. Foreign exchange
J. Other official checks or exchange items
_____ _____
MISCELLANEOUS CHECKS AND
INTANGIBLE PERSONAL PROPERTY
HELD IN THE ORDINARY COURSE
OF BUSINESS (3 years inactive)
YES
NO
YES
NO
INSURANCE (3 years inactive)
_____ _____ A. Wages, payroll or salary
A. Amounts due and payable under
_____ _____
terms of insurance policies
_____ _____ B. Commissions
_____ _____
B. Claim payments
_____ _____ C. Expense checks
C. Drafts not presented for payment
_____ _____
_____ _____ D. Workman’s Compensation benefits
_____ _____
D. Matured whole life, term endowment
_____ _____ E. Pension checks
_____ _____
E. Other amounts due under insurance
policies or annuities, policy terms or
_____ _____ F. Credit checks or memos
supplementary contracts
_____ _____ G. Payments for goods and services
_____ _____
F. Premium Refunds
_____ _____ H. Customer overpayment
YES
NO
UTILITIES (3 years inactive)
_____ _____ I. Unidentified remittances
_____ _____ J. Non-refunded overcharges
_____ _____
A. Utility deposits
_____ _____ K. Accounts payable
_____ _____
B. Membership fees
_____ _____ L. Credit balances-accounts receivables
C. Refunds or rebates
_____ _____
_____ _____ M Discounts due
_____ _____ N. Refunds or rebates
_____ _____ O. Vendor checks
YES
NO
DISSOLUTIONS/LIQUIDATIONS (1 year)
_____ _____ P. Mineral proceeds
_____ _____ Q. Royalties
_____ _____
All property distributable in the course
_____ _____ R. Any other miscellaneous
of voluntary or involuntary dissolution or
outstanding checks
liquidation which is unclaimed within
_____ _____ S. Any checks that have been written off to income
one year after the date for final distri-
_____ _____ T. Any other miscellaneous intangible
bution is presumed abandoned.
personal property
YES
NO
COURT DEPOSITS (3 years inactive)
YES
NO
TANGIBLE PROPERTY (7 years inactive)
_____ _____ A. Escrow funds
_____ _____ A. Contents of safe deposit boxes
_____ _____ B. Contents of any other safekeeping
_____ _____ B. Condemnation awards
_____ _____ C. Missing heirs funds
_____ _____
depository
_____ _____ C. Other tangible property
_____ _____ D. Suspense accounts
_____ _____ E. Any other type of deposit made with
a court or public authority
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