Form Tr-0392 - Annual Report Of Unclaimed Property Verification & Affidavit Of Safe Deposit Items For Year Ended December 31
Download a blank fillable Form Tr-0392 - Annual Report Of Unclaimed Property Verification & Affidavit Of Safe Deposit Items For Year Ended December 31 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Tr-0392 - Annual Report Of Unclaimed Property Verification & Affidavit Of Safe Deposit Items For Year Ended December 31 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Reset Form
STATE OF TENNESSEE TREASURY DEPARTMENT
Unclaimed Property Division
P.O. Box 198649 Nashville, Tennessee 37219-8649 (615) 253-5362
E-mail: UCP.holders@state.tn.us
III. ANNUAL REPORT OF UNCLAIMED PROPERTY
VERIFICATION & AFFIDAVIT OF SAFE DEPOSIT ITEMS FOR YEAR ENDED DECEMBER 31, ______
A.
Holder # __________________________________
Name
_________________________________________
Address
_________________________________________
_________________________________________
_________________________________________
E-Mail
_________________________________________
State of Incorporation _______________________
Fed Tax ID #
_________________________________________
Date of Incorporation ________________________
Name of contact person or department designated to respond to safe deposit box unclaimed property inquiries:
Name
_________________________________________
_________________________________________
Telephone
_________________________________________
_________________________________________
E-Mail
_________________________________________
_________________________________________
B. Type of company: __________________________________________________________________________________
C. Type of report:
Initial Content Report
Sale proceeds and disposition of previously reported contents
Method of report:
Compact Disk
Diskette
Paper
D. Total cash remitted (make check payable to "State Treasurer of Tennessee"): ____________________________________
E. Total shares of physical securities remitted:
_________________________________________________________
F. Face amount of bonds remitted:
_________________________________________________________
G. Amount deposited to lessee's existing account:
_________________________________________________________
H. VERIFICATION AND AFFIDAVIT: The undersigned,______________________________________________, declares
under penalty of perjury, that, to the best of (his) (her) knowledge, the foregoing report and supporting records, contain a full,
true and complete report of unclaimed property now in the possession or under the control of the holder, which is presumed
abandoned in accordance with the provisions of Tennessee Code Annotated, Sections 66-29-101 through 66-29-153. I am
duly authorized to attest to this.
Date
________________________________________
______________________________________________
Signature of Chief Financial Offi cer
State of
________________________________________
______________________________________________
Title
City/County ________________________________________
SEAL
Subscribed and sworn to before me this _________ day of ___________________ 20____
Notary Public
__________________________________________________________________________
st
SAFE DEPOSIT CONTENT REPORT DUE MAY 1
Proceeds/Disposition report due 60 days after sale/disposition.
TR-0392 (Rev. 10/05)
RDA 1153
Reporting Help: UCP.holders@state.tn.us
ADVERTISEMENT
0 votes
Related Articles
Related forms
Centrally Assessed Report For Private Car Line Companies Data For Year Ending December 31, 2007
Financial
Form Of Annual Return And Revenue Statement (combo Return) For Calendar Year Ending December 31
Legal
Form T 72 - Departament Of Revenue - Division Of Taxation - Public Service Corporation Gross Earnings Tax Return For Calendar Year Ending December 31,2007
Financial
Form T-71 - Insurance Companies Tax Return Of Gross Premiums For Calendar Year Ending December 31, 2006 - Rhode Island And Providence Plantations Department Of Revenue
Financial
Form T-72 - Public Service Corporation Gross Earnings Tax Return For Calendar Year Ending December 31,2003
Financial
Related Categories
Parent category: Financial