Form Rpd-41343 - Claim For Abandoned Property Disclosure Of Agreement To Locate Property

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STATE OF NEW MEXICO
RPD-41343
Rev. 05/06/09
TAXATION AND REVENUE DEPARTMENT
Unclaimed Property
P O Box 25123
Santa Fe, New Mexico 87504-5123
CLAIM FOR ABANDONED PROPERTY
DISCLOSURE OF AGREEMENT TO LOCATE PROPERTY
Owner Name (from claim form):_________________________________ Owner's SSN or FEIN:___________________
TRD Claim ID Number:______________________________________________
In order to verify the representations made in this form, provide claimant's direct contact information:
Claimant Name:
Claimant Address:
Claimant Daytime Phone Number:
Acknowledgment of Agreement to Locate Property
This Claim for Abandoned Property is subject to an Agreement to Locate Property which was entered into
on __________________________ (date) by and between ____________________________________ (owner
or claimant) and ____________________________________ (provider of location services). A full and complete
copy of the Agreement to Locate Property is enclosed with this form (attach copy). I/We entered into this agree-
ment freely and voluntarily with a full understanding at the time of signing of the nature of the property to be located,
the services to be rendered and the fees to be charged for the specified services to locate abandoned property.
Subscribed and sworn to before me this
___________________________________ (Owner/Claimant)
_______ day of _______________________, _______
____________________________________________
Notary Public
County & State
___________________________________ (Owner/Claimant)
My commission expires:_________________________
YES
NO
INITIAL
(This section for use by Taxation and Revenue Department only)
Has property been held by the Taxation and Revenue Department for more than 48 months?........
If property is held for less than 48 months, is Agreement made directly with a
licensed attorney?..............................................................................................................................
Is Agreement to Locate Property in writing?......................................................................................
Does Agreement clearly specify the nature of property to be located?.............................................
Does Agreement clearly specify the services to be rendered?..........................................................
Is Agreement signed by owner or person authorized to act on behalf of owner?..............................
Does Agreement state value of property before and after the fee is deducted?................................

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