Claim Form - Unclaimed Property Program
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1Cla
im Form
m
Na
ame:
C
Current Add
dress:
City,
State, Zip C
Code:
Ow
wner’s Name
as Reported
d As:
Please pr
rovide the in
nformation b
elow. Witho
out it, we can
nnot process
s your claim.
.
Y
Your SSN or
EIN
Y
Your signatur
re on the Cla
aim Form
A
A clear copy
of your phot
to ID
Y
Your daytime
e telephone n
number
A
A copy of the
e death certif
ficate if the o
owner is dec
ceased
Provide y
your Social S
Security Num
mber (SSN)
or the Empl
loyer Identif
fication Num
mber (EIN) o
of
your busi
iness or orga
anization. If
you are not
the account
owner, also
o provide the
e owner’s SS
SN.
and/or
Your S
SSN or EIN
Own
ner’s SSN if
f not Claiman
nt
I declare
e that I have
examined th
his form and
accompany
ing documen
nts and, to th
he best of my
y
knowledg
ge and belief
f, they are tr
rue, correct,
and comple
ete.
Your
Signature
Dat
te
D
Daytime Tel
lephone Num
mber:
H
How did you
find out that
t your name
was on the I
Idaho’s Unc
claimed Prop
perty List?
Relative/
/Friend
Internet
New
wspaper
TV
Spec
cial Events
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