Maryland Unclaimed Property Report
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Unclaimed Property Unit
P.O. Box 17161
Baltimore, Maryland 21297-1161
Maryland Unclaimed Property Report
HOLDER:
HOLDER NUMBER:
FOR THE YEAR ENDED:
DUE DATE:
A. If you have NO unclaimed property to
STATE OF INCORPORATION:
Alabama
report for this period, check here:
B. If you DO have unclaimed property to report:
1. Enter total dollar amount of all accounts LESS than $100.00 here: $
2. Use FORM COM/CD 919 to report:
● Individual accounts $100.00 and GREATER
● Securities (stocks, bonds, certificates, etc.)
● Safe Deposit Boxes
● 10 Accounts or less
Enter total number of unclaimed accounts $100.00 and GREATER listed on FORM COM/CD 919 here:
IMPORTANT: We will notify owners to call you about this report, at:
, unless you give a preferred telephone number here:
I declare under penalty of perjury that this report (including any accompanying schedules and statements)
has been examined by me and to the best of my knowledge is a true and complete report.
______________________________________
____________________
____________________
Signature
Title
Date
Federal I.D. Number:
Name of Company or Corporation:
Mailing Address:
Location Address:
City & State:
Zip Code:
Contact Person:
Telephone Number for Contact Person:
E-mail for Contact Person:
COD/CD 918 05/2016
(410) 767-1700 OR Toll Free 1(800) 782-7383
FAX: (410) 333-7150
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