Extension Request Form - New York Office Of The State Comptroller

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THOMAS P. DiNAPOLI
110 STATE STREET
ALBANY, NEW YORK 12236
STATE COMPTROLLER
STATE OF NEW YORK
OFFICE OF THE STATE COMPTROLLER
OFFICE OF UNCLAIMED FUNDS
EXTENSION REQUEST
To request an extension of time to complete activities relative to your abandoned property filing, complete the
form below and return to the Office of Unclaimed Funds, 110 State Street, Albany, New York, Attn.: Reports
Processing Unit; or via email at NYSRPU@osc.state.ny.us; or fax at 518-270-2220.
Please note, if a final report filing extension is granted, payment is still due as mandated while the report’s detail
can follow on a later date. If the value of a final report has not been determined, the payment may be estimated.
An estimated payment would be either 75% of the expected report’s value, if known, or 75% of the previous
year’s report value. Any request for an extension in time should be received in our office at least 30 days prior to
the event due date.
Direct any questions to the Office of Unclaimed Funds, Reports Processing Unit at NYSRPU@osc.state.ny.us, or
contact our Communication Center at 1-800-221-9311.
EXTENSION REQUEST FORM
We respectfully request an extension of time to complete the below checked activities relative to our abandoned
property filing. The final report and payment relating to this filing are due on
.
Preliminary Report
Proof of Publication Affidavit
Due Diligence
Final Report*
Additional Time Requested:
30 days
60 days
90 days
We are applying for this extension based on the reason(s) below. Please check as appropriate and provide a
brief explanation:
System Problems
New System Transfer Agent
Transfer Agent Change
Personnel Changes
Additional Time Requested:
30 days
Other
Please Explain:
Federal
Reporting Organization Name
Employer
& Address
ID No.
Telephone
Contact Name
Contact Title
Fax
Contact Email
Contact Signature
Date
RESERVED FOR USE BY OFFICE OF THE STATE COMPTROLLER
EXTENSION APPROVED
EXTENSION DENIED
ACTIVITY DUE DATE
Approved/Denied by:
Date: ____________________

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