Form Up-3a - Safe Deposit Box Or Other Safekeeping Repository Owner Information

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SAFE DEPOSIT BOX OR OTHER SAFEKEEPING REPOSITORY
UP-3A
OWNER INFORMATION
______________________________________________________________________________________________________ Page ______ of _______
Holder/Branch
STORAGE BOX
________ OF ________
PROPERTY CODE
OWNER BOX/UNIT
ABANDONED (MM DD YY)
HOLDER CHARGES
(State Use Only)
OWNER LAST NAME (1)
OWNER FIRST NAME
MI
OWNER SS# / FID #
NO. OF OWNERS
SUFFIX
OWNER LAST NAME (2)
OWNER FIRST NAME
MI
SUFFIX
OWNER SS# / FID #
TITLE/OTHER
OWNER STREET ADDRESS 1
OWNER STREET ADDRESS 2
CITY
STATE
ZIP
COUNTRY (IF NOT U.S.)
COMMENT FIELD
SAFE DEPOSIT BOX CONTENT LISTING
ESTIMATED
CATEGORY #
SUBCATEGORY
QUANTITY
DESCRIPTION OF ITEM
VALUE
STORAGE BOX
________ OF ________
PROPERTY CODE
OWNER BOX/UNIT
ABANDONED (MM DD YY)
HOLDER CHARGES
(State Use Only)
OWNER LAST NAME (1)
OWNER FIRST NAME
MI
OWNER SS# / FID #
NO. OF OWNERS
SUFFIX
OWNER LAST NAME (2)
OWNER FIRST NAME
MI
SUFFIX
OWNER SS# / FID #
TITLE/OTHER
OWNER STREET ADDRESS 1
OWNER STREET ADDRESS 2
CITY
STATE
ZIP
COUNTRY (IF NOT U.S.)
COMMENT FIELD
SAFE DEPOSIT BOX CONTENT LISTING
ESTIMATED
CATEGORY #
SUBCATEGORY
QUANTITY
DESCRIPTION OF ITEM
VALUE

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Parent category: Business
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