Form Up-Exp/ext - Application For Extension Of Time To File Unclaimed Property Report Exemption Of Electronic Filing Requirement

ADVERTISEMENT

Unclaimed Property
Approved K Yes K No
By _____________________
Office of the State Treasurer
Date ___________________
APPLICATION FOR
EXTENSION OF TIME TO FILE UNCLAIMED PROPERTY REPORT
EXEMPTION OF ELECTRONIC FILING REQUIREMENT
HOLDER INFORMATION
Holder Name
FEIN or TIN
Address
Contact Phone #
City, State, Zip Code
Contact Fax #
Contact Person Name
State of Incorp.
2008
Contact Person Title
Report Year
Email address ________________________________________________
Estimated amount to be reported___________________
K
K
(please check one)
I request an extension of
from filing our Unclaimed
I request an exemption
Property Report electronically due to the following:
All Holders except
Life Insurance and Gift
noted to the right
Obligation Issuers
K
We have less than 10 items to report.
K 30 days until
December 1
June 1
K
K 60 days until
We do not have the technical ability to meet this requirement at this time.
January 1
July 1
K 90 days until
February 1
August 1
K
Other (please explain) __________________________________________
K 120 days until
March 1
September 1
from the original due date of November 1 (May 1 for Life Insurance
_____________________________________________________________________
Companies and Issuers of Gift Certificate/Obligations) to file the
Unclaimed Property Report for the company listed above.
_____________________________________________________________________
Signature
Title or Agent Relationship
Print Name
Date
K
K
Reason for extension or –
Plan for filing electronically next year:
Use this application to obtain an extension of time to file your Unclaimed Property Report
INSTRUCTIONS:
INSTRUCTIONS:
Use this application to obtain an extension of time to file your Unclaimed Property Report
or an exemption from filing your Unclaimed Property Report electronically. Please include your company’s
or an exemption from filing your Unclaimed Property Report electronically. Please include your company’s
Federal Tax ID (FEIN). State why and how long of an extension you need or why you cannot comply with
Federal Tax ID (FEIN). State why and how long an extension you need or why you cannot comply with
electronic reporting. Mail this completed application form to Office of the State Treasurer, Attn: Unclaimed
electronic reporting. Mail this completed application form to Office of the State Treasurer, Attn: Unclaimed
Property, 39 State House Station, Augusta, ME 04333-0039 or fax to 207-287-2367. We will reply by fax or
Property, 39 State House Station, Augusta, ME 04333-0039 or fax your application to 207-287-2367. We will
e-mail.
reply by fax.
15
UP-EXP/EXT 6/09

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go