Form Wup-1 - Report Of Unclaimed Property - Verification And Checklist
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5WUP-1 - 05/13
WUP-WEB
MARK GORDON
REPORT OF UNCLAIMED PROPERTY
STATE TREASURER OF WYOMING
VERIFICATION AND CHECKLIST
WYOMING STATE TREASURER’S OFFICE
UNCLAIMED PROPERTY DIVISION
DUE DATE: NOVEMBER 1ST
CHECK APPLICABLE BOX:
FIRST FILING
ANNUAL REPORT YEAR
SUPPLEMENTAL REPORT YEAR
HOLDER INFORMATION:
FEDERAL EMPLOYER’S ID NUMBER:
Verification for Period Ended June 30, 20
Name
If this report includes property held by subsidiary companies, list
the name and address of the parent company:
Address
City/State/ZIP
If this report includes property held by subsidiary companies, list
the name(s) and
address(es)
of those
companies:
State of Incorporation
SIC Code
Date of Incorporation/Charter Date
Number of branches included in this report
List the name(s) and Federal Employer’s ID number(s) of all
previous holders of the property if you are a successor. If you
Number of subsidiaries included in this report
have changed your name during the time in which you held the
property, list the prior name(s), state of incorporation, date the
Is the holder:
corporation changed hands, and the Federal Employer’s ID
number(s).
A Subsidiary (wholly owned)
A Division
Publicly Traded
Private
A Government Entity
Other
Do any other departments, branches or subsidiaries file reports
using the FEIN noted above?
Yes
No
If yes, complete the information on the next column.
Indicate which of the following best describes the primary activity of
your company (check one):
Banking/Trust
Transportation
Oil and Gas
Government
Savings & Loan
Services
Mutual Funds
Schools, Colleges,
Credit Union
Utilities/Cable Co.
Financial/Investments
Universities
Construction
Health Care Facilities
Life Insurance
Other (specify)
Manufacturing
Retail
Other Insurance
NEGATIVE REPORT (a.k.a. “Zero Report”): Effective with the 2006 Annual Reporting Period, Negative Reports are no
longer required. Do not forward any to this office.
Are any securities transmitted on Form WUP-3 with this report?
Yes
No
Are any safe deposit box contents transmitted on Form WUP-4 with this report?
Yes
No
1.
Enter grand total amount from WUP-2
$
2.
Enter cash transmitted from SAFE DEPOSIT BOX CONTENTS
$
0.00
3.
Total Amount of Unclaimed Property (Add lines 1 and 2)
$
0.00
REMITTANCE TO WYOMING STATE TREASURER:
Check No.
Amount $
WYOMING STATE TREASURER'S OFFICE - UNCLAIMED PROPERTY DIVISION
FEDERAL TAX IDENTIFICATION NUMBER IS: 83-0208667
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