Form Rpd-41204 - List Of Unclaimed Contents Of Safe Deposit Boxes Or Other Safekeeping Repositories

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LIST OF UNCLAIMED CONTENTS OF SAFE DEPOSIT BOXES
RPD-41204
REV 02/2007
OR OTHER SAFEKEEPING REPOSITORIES
Form RPD-41204
Page No._____ of ______
Holder (Name of Business)
Report Year
Address
Federal ID#
State
City
ZIP Code
Period Covered MM/DD/YY
F
r
o
m
:
T
o
:
Contact Name
Daytime Phone Number
Owner Name
Last Known Address
Social Security #
Safe Deposit Box
No.
Description of Articles
Number & Street City, State, ZIP
or Federal Tax
or Identifying #
of
ID #
Items
Last
First
Middle
(2)
(3)
(4)
(5)
(1)
(6)

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