Schedule A - Unclaimed Property Report - Vermont Unclaimed Property Division
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1Vermont State Treasurer’s Office -- Unclaimed Property Division
109 State Street, Montpelier, Vermont 05609-6200
UNCLAIMED PROPERTY REPORT -
SCHEDULE A
Holder Name ___________________________________
Holder FEIN ___________________ Report Date ____________________
Holder ID ______________________________________
For Year Ended _________________
Last Transaction or
Owner’s Last Name, First Name,
Cash Amount
Cash Amount
Date Property
SSN/FEIN
Middle Name;
Remitted
Originally Owed to owner
Became Payable or
Account No.
Owner’s Last Known Street Address
Distributable to the
City, State, Zip
Owner
1
2
3
4
5
6
7
8
Page No. ____________ of ___________
Number of Properties ________________
Page Total $ ________________________
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