Form Up-2a - Unclaimed Property Report - Owner Information Page 2
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2State of New Jersey
UP-2a (4-96)
State of New Jersey
DIVISION OF TAXATION
PROPERTY ADMINISTRATION
UNCLAIMED PROPERTY REPORT - OWNER INFORMATION
(Omit all punctuation)
Page ______ of ______
For Period Ended
__________________________________________________________________
________________ 19____
HOLDER
SC-BEARER BOND INTEREST (no check issued)
REC
OWNER LAST NAME
FIRST NAME
M.I. SUFFIX
OWNER ID/SS#
NO. OF OWNERS
OWNERSHIP TITLE
NO.
GLOUC CO UTIL
AUTH
OWNER ADDRESS STREET 1
OWNER ADDRESS STREET 2
CITY
STATE
ZIP
COUNTRY
(IF NOT U.S.)
PROPERTY CODE
PROPERTY ID NUMBER
DATE (MM DD YY)
CASH REPORTED
SECURITIES
TRANSFER
OWNER CUSIP #
REPORTED
METHOD
SC40
B424467
$500.00
OWNER CERTIFICATE ID NO.
DATED DATE OF
DESCRIPTION OF PROPERTY / ISSUE NAME
GLOUCESTER COUNTY UTILITIES AUTHORITY SEWER
REMITTED SECURITIES
REVENUE (1978 “A”) DTD 7-1-78 5.00%
DUE 1-1-92 768/770,771
CASH DIVIDEND(s)
From:
To:
SC42 BEARER BOND PRINCIPAL (check issued)
REC
NO.
OWNER LAST NAME
FIRST NAME
M.I. SUFFIX
OWNER ID/SS#
NO. OF OWNERS
OWNERSHIP TITLE
DOE
JOHN
L
142-22-9999
OWNER ADDRESS STREET 1
OWNER ADDRESS STREET 2
CITY
STATE
ZIP
COUNTRY
(IF NOT U.S.
10 FRIENDLY LANE
FANTASY
NJ
77777
PROPERTY CODE
PROPERTY ID NUMBER
DATE (MM DD YY)
CASH REPORTED
SECURITIES
TRANSFER
OWNER CUSIP #
REPORTED
METHOD
SC41
$500.00
OWNER CERTIFICATE ID NO.
DATED DATE OF
DESCRIPTION OF PROPERTY / ISSUE NAME
REMITTED SECURITIES
CASH DIVIDEND(s)
From:
To:
SC42 BEARER BOND PRINCIPAL (no check issued)
REC
NO.
OWNER LAST NAME
FIRST NAME
M.I. SUFFIX
OWNER ID/SS#
NO. OF OWNERS
OWNERSHIP TITLE
GLOUC CO UTIL
AUTH
OWNER ADDRESS STREET 1
OWNER ADDRESS STREET 2
CITY
STATE
ZIP
COUNTRY
(IF NOT U.S.)
PROPERTY CODE
PROPERTY ID NUMBER
DATE (MM DD YY)
CASH REPORTED
SECURITIES
TRANSFER
OWNER CUSIP #
REPORTED
METHOD
SC42
$20,000.00
379700B29
OWNER CERTIFICATE ID NO.
DATED DATE OF
DESCRIPTION OF PROPERTY / ISSUE NAME
REMITTED SECURITIES
GLOUCESTER COUNTY UTILITIES AUTHORITY SEWER
REVENUE (1978 “A”) DTD 7-1-78 5.00%
MAT. 1-1-92 768/770.771
CASH DIVIDEND(s)
CALL 1-1-90 @ 100% -0- ACCRUED INTEREST
From:
To:
SC43 - BEARER BOND PRINCIPAL (check issued)
REC
NO.
OWNER LAST NAME
FIRST NAME
M.I. SUFFIX
OWNER ID/SS#
NO. OF OWNERS
OWNERSHIP TITLE
DOE
JOHN
L
142-22-9999
OWNER ADDRESS STREET 1
OWNER ADDRESS STREET 2
CITY
STATE
ZIP
COUNTRY
(IF NOT U.S.)
10 FRIENDLY LANE
FANTASY
NJ
77777
PROPERTY CODE
PROPERTY ID NUMBER
DATE (MM DD YY)
CASH REPORTED
SECURITIES
TRANSFER
OWNER CUSIP #
REPORTED
METHOD
SC43
B424467
$20,000.00
OWNER CERTIFICATE ID NO.
DATED DATE OF
DESCRIPTION OF PROPERTY / ISSUE NAME
REMITTED SECURITIES
CASH DIVIDEND(s)
From:
To:
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