Form Wup-4 - List Of Owners Of Unclaimed Contents Of Safe Deposit Boxes Or Other Safekeeping Repositories

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WUP-4 - 06/01
STATE OF WYOMING
WUP-WEB
LIST OF OWNERS OF UNCLAIMED CONTENTS OF SAFE DEPOSIT BOXES OR OTHER SAFEKEEPING REPOSITORIES
FORM WUP-4
Page No. __________ of ___________
HOLDER (Name of Business)
Report Year_______
I HEREBY CERTIFY THAT THE ITEMS LISTED BELOW, IF ANY, ARE TRUE AND
CORRECT.
ADDRESS
FED ID#
Name and Title of Officer: _________________________________________________________
CITY/STATE/ZIP
Period Covered MO/DAY/YR
Signature: _______________________________________________________________________
From:
To:
Contact Person:_________________________________________ Telephone Number: (
)__________________________
No. of Items
Description of Articles
Nature of
Owner
Owner Name
Last Known Address
Safe Deposit
Date When
Date of
Social Security No. or
Box
Lease or
Opening of
Funds
Federal Tax ID No.
Identifying No.
Rental Period
Safe Deposit
Type
Last
First
Middle
No. & Street/City/State /ZIP
Expired
Box or
Code
County
Other
Safekeeping
This is a 2-line field - press enter to go to
This is a 2-line field - press enter to go to 2nd line
This is a 2-line field - press enter to go to 2nd line
Repository
2nd line
(1)
(4)
(5)
(6)
(7)
(8)
(9)
(2)
(3)

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