Form Asd-127 - Abandoned Tangible Personal Property

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North Carolina Department of State Treasurer
Holder Name:
ABANDONED TANGIBLE PERSONAL PROPERTY
Holder FIN:
Branch Location:
ASD-127 (Revised 4/11)
Name of Contact Person:
Phone number of Contact Person:
PLEASE READ INSTRUCTIONS ON REVERSE SIDE BEFORE COMPLETING FORM
Safe Deposit
Social
Safe Deposit
Box #
Owner's Name:
Security
Owner's Address:
Box - Past
or Identifier #
Number:
Due Rent*
Office Use Only
Office Use Only
Description of Items
Destroy
Submit
Description of Items
Destroy
Submit
Safe Deposit
Social
Safe Deposit
Box #
Owner's Name:
Security
Owner's Address:
Box - Past
or Identifier #
Number:
Due Rent*
Office Use Only
Office Use Only
Description of Items
Destroy
Submit
Description of Items
Destroy
Submit
Safe Deposit
Social
Safe Deposit
Box #
Owner's Name:
Security
Owner's Address:
Box - Past
or Identifier #
Number:
Due Rent*
Office Use Only
Office Use Only
Description of Items
Destroy
Submit
Description of Items
Destroy
Submit
FORM MAY BE DUPLICATED

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