Unclaimed Property Report - Currency Form - Office Of The State Treasurer - Wisconsin
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1Unclaimed Property Report – Currency
S TAT E O F W I S C O N S I N • O F F I C E O F T H E S TAT E T R E A S U R E R
Mail to: Unclaimed Property Unit, Office of the State Treasurer, PO Box 2114, Madison WI 53701-2114
A
C
Holder Name:
Report Year:
B
FEIN#/SS#:
Page __________ of __________
D
E
F
G
H
I
J
K
L
Owner Name
Last Known Address
Birthdate
Social Security
Property
Last Activity
Account #
Draft /
Amount
(Last, First, Middle Initial)
(Street, City, State, Zip)
or Federal Tax ID
Code
Date
Certificate #
Check #
Remitted
Number
Policy #
M
$
TOTAL remitted for this page
A computer printout with the above-noted information is acceptable for reports of 10 properties or less.
N
$
Report TOTAL (last page only)
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Parent category: Legal