TUP 40
Commonwealth of Pennsylvania
( -10)
Treasury Department
BUREAU OF UNCLAIMED PROPERTY
Finance Building, Vault
Robert M. McCord
Commonwealth and North Streets
Harrisburg, PA 17120
Treasurer
UNCLAIMED PROPERTY ~ TANGIBLE ASSETS INVENTORY LIST ~
(MUST BE TYPED)
REPORT OF________________________________________________________________________________________________________________
(Name of Reporting Organization) Holder
(Address)
(Branch)
(Reporting Year)
NAME OF INDIVIDUAL PREPARING REPORT _______________________________________ PHONE NUMBER (_____)______________________
(Signature)
EMAIL ADDRESS __________________________________________________________ EIN _____________________________________________
TYPE OF PROPERTY
{
REFERENCE NUMBER
OWNER NAME
STREET ADDRESS
CITY
STATE
ZIP CODE LAST ACTIVITY DATE
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
SOCIAL SECURITY NO.
PROPERTY DESCRIPTION
QUANTITY
(optional)
{
1
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_________________________________________________________________________________________________________________
{
2
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_________________________________________________________________________________________________________________
{
3
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_________________________________________________________________________________________________________________
{
4
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_________________________________________________________________________________________________________________
{
5
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_________________________________________________________________________________________________________________
{
6
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_________________________________________________________________________________________________________________
{
7
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_________________________________________________________________________________________________________________
{
8
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_________________________________________________________________________________________________________________
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