Form - Affidavit For Amendment Of Report Of Unclaimed Property Filed With The Oklahoma State Treasurer'S Office, Unclaimed Property Division

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AFFIDAVIT FOR AMENDMENT OF REPORT OF UNCLAIMED PROPERTY
FILED WITH THE OKLAHOMA STATE TREASURER'S OFFICE,
UNCLAIMED PROPERTY DIVISION,
BY__________________________________________(Company)
I, __________________________________, being of lawful age and being
first duly sworn upon oath state as follows:
1.
I am an officer of Company and am authorized to make this
amendment for the Company.
2.
Properties were reported and remitted by the Company to the
Oklahoma State Treasurer, Unclaimed Property Division on a Report
dated_________. A copy of the pertinent portion of the Report is enclosed.
3.
The Company amends this Report of Unclaimed Property in the
following manner:
Property Identification _______________________________
Reported Information
Amended Information
The Company agrees to indemnify and hold harmless the Oklahoma State
Treasurer's Office and its employees from any claims resulting from this
amendment.
I declare under the penalties of perjury that I have examined this amendment
and to the best of my knowledge and belief it is true, correct, complete, and made
in good faith, for the reporting of unclaimed property to the Oklahoma State
Treasurer's Office.
Signature:______________________________
Printed name:___________________________
Title:__________________________________
State of ____________________
County of _________________
Subscribed and sworn to before the undersigned notary public this ___ day
of _______________, 20__.
My commission expires:_________
_________________________
Notary public
Commission no._________
[seal]

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