Verification Summary For Unclaimed Property

ADVERTISEMENT

VERIFICATION SUMMARY FOR UNCLAIMED PROPERTY
SEE INSTRUCTIONS ON REVERSE SIDE
HOLDER NAME & ADDRESS:
_________________________________________________
REQUIRED INFORMATION
______________________________________________________
VERIFICATION FOR PERIOD ENDED _______________________ , 19____
______________________________________________________
STATE OF INCORPORATION ____________________________________
______________________________________________________
DATE OF INCORPORATION _____________________________________
______________________________________________________
PRIMARY BUSINESS ACTIVITY __________________________________
______________________________________________________
FEDERAL IDENTIFICATION # ____________________________________
PLEASE ENTER THE AMOUNT BEING REPORTED FOR EACH PROPERTY TYPE IN THE APPROPRIATE SPACE.
DEPOSIT ACCOUNTS
MISCELLANEOUS PROPERTY TYPES
AC01 CHECKING ACCOUNT/DEMAND DEPOSITS $ ______________
MS01 PAYROLL/WAGES/SALARY
$ ______________
AC02 SAVINGS ACCOUNTS
______________
MS02 COMMISSIONS
______________
AC03 MATURED CERTIFICATES
MS03 WORKER'S COMPENSATION BENEFITS
______________
AC05 MONEY ON DEPOSIT TO SECURE FUNDS
______________
MS04 PAYMENT FOR GOODS & SERVICES
______________
AC06 SECURITY DEPOSITS
______________
MS05 CUSTOMER OVERPAYMENT
______________
AC07 UNIDENTIFIED DEPOSITS
______________
MS06 UNIDENTIFIED REMITTANCE
______________
AC08 SUSPENSE ACCOUNTS
______________
MS07 UNREFUNDED OVERCHARGE
______________
AC99 AGGREGATE REPORTING
______________
MS08 ACCOUNTS PAYABLE
______________
MS09 CREDIT BALANCE & ACCTS REC CHECKS
______________
CHECKS
MS10 DISCOUNTS DUE
______________
CK01 CASHIER'S CHECK
______________
MS11 REFUNDS DUE
______________
CK02 CERTIFIED CHECKS
______________
MS12 UNREDEEMED GIFT CERTIFICATES
______________
CK03 REGISTERED CHECKS
______________
MS13 UNCLAIMED LOAN COLLATERAL
______________
CK04 TREASURER'S CHECKS
______________
MS14 PENSION/PROFIT SHARING
______________
CK05 DRAFTS
______________
MS15 PROP DIST DURING LIQUIDATION
______________
CK06 WARRANTS
______________
MS16 MISC OUTSTANDING CHECKS
______________
CK07 MONEY ORDERS
______________
MS17 MISC INTANGIBLE PERS PROP
______________
CK08 TRAVELER'S CHECKS
______________
MS18 SUSPENSE LIABILITES
______________
CK09 FOREIGN EXCHANGE CHECKS
______________
MS99 AGGREGATE, MISC
______________
CK10 EXPENSE CHECK
______________
SECURITY RELATED
CK11 PENSION CHECKS
______________
CK12 CREDIT CHECKS OR MEMOS
______________
SC01 DIVIDENDS
______________
CK13 VENDOR CHECKS
______________
SC02 INTEREST-BOND COUPONS
______________
CK14 CHECKS WRITTEN OFF TO INCOME
______________
SC03 PRINCIPAL PAYENTS
______________
CK15 OUTSTANDING OFFICIAL CHECKS
______________
SC04 EQUITY PAYMENTS
______________
CK16 CD INTEREST CHECKS
______________
SC05 PROFITS
______________
CK99
______________
SC06 FUNDS PAID TO PURCHASE SHARES
______________
AGGREGATE UNCASHED CHECKS-LESS THAN $50
SC07 FUNDS FOR STOCK AND BONDS
______________
COURT RELATED
SC08 SHARES OF STOCK RET BY POST OFFICE
______________
CT01 ESCROW FUNDS
______________
SC09 CASH FOR FRACTIONAL SHARES
______________
CT02 CONDEMNATION AWARDS
______________
SC10 UNEXCH STOCK OF SUCCESSOR
______________
CT03 MISSING HEIRS' FUNDS
______________
SC11 ANY OTHER CERT OF OWNERSHIP
______________
CT04 SUSPENSE ACCOUNTS
______________
SC12 UNDERLYING SHARES OUTSTANDING
______________
CT05 OTHER COURT DEPOSITS
______________
SC13 FUNDS FOR LIQUIDATION
______________
CT99 AGGREGATE COURT DEPOSITS
______________
SC14 DEBENTURES
______________
INSURANCE REALTED
SC15 US GOVT SECURITIES
______________
IN01
INDIVIDUAL POLICY BENEFIT
______________
SC16 MUTUAL FUND SHARES
______________
IN02
GROUP POLICY BENEFIT
______________
SC17 WARRANTS (RIGHTS)
______________
IN03
PROCEEDS DUE BENEFICIARY
______________
SC18 MATURED BOND PRINCIPAL
______________
IN04
PROCEEDS-MATURED POL,
______________
SC19 DIVIDEND REINVESTMENT PLANS
______________
SC20 CREDIT BALANCES
______________
ENDOWMENTS, ANNUITIES
______________
SC21 COMMON STOCK
______________
IN05
PREMIUM REFUND ON INDVIDUAL POLICY
______________
IN06
UNIDENTIFIED REMITTANCE
______________
SC22 CONVERTIBLE SECURITIES
______________
IN07
OTHER AMTS DUE UNDER POLICY
______________
SC23 PREFERRED SECURITIES
______________
IN08
AGENT CREDIT BALANCE-COMMISSIONS
______________
SC24 FIXED INCOME SECURITY
______________
IN99
AGGREGATE INSURANCE
______________
SC25 REAL ESTATE - BASED SECURITY
______________
SC99 AGGREGATE SECURITY RELATED
______________
MINERAL PROCEEDS
TANGIBLE PROPERTY
MI01
NET REVENUE INTEREST
______________
MI02
ROYALTIES
______________
SD01 SAFE DEPOSIT BOX CONTENTS
______________
MI03
OVERRIDING ROYALTIES
______________
SD02 OTHER SAFE KEEPING
______________
SD03 OTHER TANGIBLE PROPERTY
______________
MI04
______________
PRODUCTION PAYMENTS, TANGIBLE PROPERTY
MI05
WORKING INTEREST
______________
RELATED TRUST
MI06
BONUSES
______________
TR01 PAYING AGENT ACCOUNT
______________
MI07
DELAY RENTALS
______________
TR02 UNDELIVERED/UNCASHED DIVIDENDS
______________
MI08
SHUT-IN ROYALTIES
______________
TR03 FUNDS HELD IN FIDICUIARY CAP
______________
MI09
MINIMUM ROYALTIES
______________
TR04 ESCROW ACCOUNTS
______________
UTILITY RELATED
TR05 TRUST VOUCHERS
______________
UT01 UTILITY DEPOSITS
______________
TR99 AGGREGATE TRUST RELATIONS
______________
UT02 MEMBERSHIP FEES
______________
UT03 REFUNDS OR REBATES
______________
UT04 CAPITAL CREDIT DISTRIBUTIONS
______________
UT99 AGGREGATE UTILITY PROPERTY
______________
I DECLARE THAT THIS REPORT, INCLUDING ACCOMPANYING STATEMENTS, HAS BEEN EXAMINED BY ME; THAT I AM DULY AUTHORIZED BY THE HOLDER
HEREIN TO EXECUTE THIS REPORT; AND THAT I BELIEVE SAID REPORT IS TRUE, CORRECT AND COMPLETE FOR THE STATED PERIOD.
SIGNATURE ____________________________ DATE ___________
CONTACT PERSON _____________________________________
TITLE___________________________________________________
TELEPHONE NUMBER (
)_______________________________
ANNUAL REPORT OF_____PAGES TOTALING $ _______________
ADDRESS ____________________________________________
____________________________________________
1 Public Use
2 UPD Use Only
UPC 1 –8/97
THIS FORM MUST ACCOMPANY THE REPORT OF UNCLAIMED PROPERTY

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Upc-1 - Verification Summary For Unclaimed Property Form Upc-1 - Verification Summary For Unclaimed Property Business
Summary Of Unclaimed Property Form - Kansas Office Of The State Treasurer Summary Of Unclaimed Property Form - Kansas Office Of The State Treasurer Legal
Form Rev 80 0004-2 - Summary Report For Unclaimed Property - Washington State Department Of Revenue Form Rev 80 0004-2 - Summary Report For Unclaimed Property - Washington State Department Of Revenue Financial
Form Ac2709 - Verification And Checklist For Unclaimed Property Form Ac2709 - Verification And Checklist For Unclaimed Property Legal
Form 04-720.a - Verification For Unclaimed Property - 2008 Form 04-720.a - Verification For Unclaimed Property - 2008 Financial
Form Ac2709 - Verification And Checklist For Unclaimed Property Form Ac2709 - Verification And Checklist For Unclaimed Property Financial
Form 04-720a - Verification For Unclaimed Property Form 04-720a - Verification For Unclaimed Property Financial
Form 04-720a - Verification For Unclaimed Property - Alaska Department Of Revenue Form 04-720a - Verification For Unclaimed Property - Alaska Department Of Revenue Financial
Form 04-720.a - Verification For Unclaimed Property - Alaska Department Of Revenue Form 04-720.a - Verification For Unclaimed Property - Alaska Department Of Revenue Financial
Form Ac2709 - Verification And Checklist For Unclaimed Property Form Ac2709 - Verification And Checklist For Unclaimed Property Legal

Related Categories

Parent category: Legal
Download
Go