Form Wup-4 - List Of Owners Of Unclaimed Contents Of Safe Deposit Boxes Or Other Safekeeping Repositories

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WUP-4 – 05/13
WUP-WEB
STATE OF WYOMING
LIST OF OWNERS OF UNCLAIMED CONTENTS OF SAFE DEPOSIT BOXES OR OTHER SAFEKEEPING REPOSITORIES
FORM WU P-4
This form is used when reporting less than 10 owners.
You must file your report electronically if reporting 10 or more owners.
Report Year
HOLDER (Name of Business)
FED ID#
ADDRESS
I HEREBY CERTIFY THAT THE ITEMS LISTED BELOW ARE TRUE AND CORRECT.
Period Covered MO/DAY/YR
Name and Title of Officer:
CITY/STATE/ZIP
From:
To:
Signature:
Contact Person: ______________________________________
Telephone Number: (
) _____________________________________
Owner Name
Last Known Address
Owner
Date When
Date of
No. of Items
Number of
Description of Articles
Social Security No. or
Safe Deposit
Lease or
Opening of
Funds
Last
First
Middle
No. & Street/City/State/Zip
Federal Tax ID No.
Box
Rental
Safe Deposit
Type
County
Identifying
Period
Box or
Code
This is a 2-line field – press enter to
nd
No.
Expired
Other
go to 2
line
nd
nd
This is a 2-line field – press enter to go to 2
line
This is a 2-line field – press enter to go to 2
line
Safekeeping
Repository
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)

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