Form 4305 - Attestation Of Compliance With Unclaimed Property Reporting
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Michigan Department of Treasury
4305 (Rev. 01-11)
Attestation of Compliance with Unclaimed Property Reporting
(No Unclaimed Property to Report)
An authorized representative of an entity having no unclaimed property reportable under the Uniform Unclaimed Property
Act (1995 PA 29, Michigan Compiled Law 567.221-567.265) must complete this form and file it with the Michigan
Department of Treasury.
By my signature below, I attest to the following:
I am an authorized representative of the entity named below.
I am aware of the unclaimed property types and dormancy periods under the Uniform Unclaimed Property Act.
The entity named below has no unclaimed property in its possession that has reached its legal dormancy according to
the Act.
I acknowledge that Section 31(2) of the Uniform Unclaimed Property Act provides authority to the State Treasurer to
conduct an examination of the company's books and records.
I am aware that an unclaimed property examination will cover up to the last ten reportable years and result in
assessment of penalty and interest.
Entity Name
Federal Employer Identification Number
TR or ME Number (if applicable)
Address
City, State, ZIP Code
Primary Business Activity
Authorized Representative (print or type)
Title of Authorized Representative
E-mail Address of Authorized Representative
Telephone Number of Authorized Representative
Signature of Authorized Representative
Date
Visit the Michigan Department of Treasury Web site at for more information on
the Uniform Unclaimed Property Act. If you have questions, contact the Unclaimed Property Division at (517) 636-6940.
Return completed form to:
Unclaimed Property Division
Michigan Department of Treasury
P.O. Box 30756
Lansing, MI 48909
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Parent category: Financial