Form Rev 80 0008-1 - Detail Report For Unclaimed Property
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1DETAIL REPORT FOR UNCLAIMED PROPERTY
State of Washington
Department of Revenue
Unclaimed Property Section
(A) HOLDER ____________________________
(D) PAGE ______ OF ______
PO Box 448
Olympia, WA 98507-0448
(B) HOLDER # __________________________
(360) 753-5538
(C) REPORT YEAR 19_______
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T
Amt. Due
y
Last Known
Owner’s
Last
Owner
Amt. of
p
Category
Owner’s Last Name,
Mailing Address,
Social
Activity
Before
Deduction
Int.
Amount
e
(A)
Code
ID #
First, and Middle
City, State, Zip Code
Security #
Date
Deductions
(B)
Rate
Remitted
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1
AGGREGATES: Please begin aggregates (items less than $25.00) on this line
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(F)
Page
Totals
(G) IF THIS IS LAST PAGE OF REPORT, ENTER GRAND TOTAL __________________
Retain a copy for your records.
DISTRIBUTION: Original - Department of Revenue
FORM REV 80 0008-1 (6-3-96)
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Parent category: Financial