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Request For Extension Of Time To File Unclaimed Property Report - Virginia Department Of The Treasury

DEPARTMENT OF THE TREASURY

DIVISION OF UNCLAIMED PROPERTY

REQUEST FOR EXTENSION OF TIME TO FILE

UNCLAIMED PROPERTY REPORT

COMPANY NAME______________________________________________________________

FEDERAL TAX ID # ____________________________________________________________

ADDRESS ___________________________________________________________________

CITY, STATE, ZIP _____________________________________________________________

CONTACT PERSON ___________________________________________________________

PHONE NUMBER____________________________FAX NUMBER______________________

E-MAIL ADDRESS_____________________________________________________________

Please provide a brief explanation why the additional time is required:

___________________________________________________________________________

REQUESTED EXTENSION DATE:

_________________________

ESTIMATED AMOUNT OF REPORT TO BE FILED:

$ ________________________

ESTIMATED NUMBER OF OWNERS ON REPORT:

_________________________

____________________________

_________________________

Signature

Date

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

FOR DIVISION USE ONLY

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Your request for an extension has been granted.

*Please note – The granting of an extension of time to file does not relieve you of the

obligation to remit unclaimed funds to the Commonwealth by the date due (Nov. 1 or May 1

for insurance companies). If you do not remit an estimated payment of the amount due,

interest will accrue at the same rate as is applicable to delinquent taxes under §58.1-1812.

Your report is due: ___________________

Your request for an extension has been denied. Please report and remit prior to the due

date as required by statute.

Approved by

Date

E-Mail to:

Report.Remit@trs.virginia.gov

, or

Mail to: Department of the Treasury, Division of Unclaimed Property, attn R/R Supervisor,

P. O. Box 2478, Richmond, VA 23218-2478

Request For Extension Of Time To File Unclaimed Property Report - Virginia Department Of The Treasury