Claim Form - Minnesota Department Of Commerce printable pdf download

Instruction for Completing

Claim Form

Filing as an Heir if the Owner is Deceased

Provide a copy of the certified Death Certificate AND

ONE of the following:

A. REPORTED PROPERTY INFORMATION

-A copy of the certified owner’s Will, or

-A copy of the certified Letters of Administration, or

1. Print the Property ID of the property being

-A copy of the certified Letters of Testamentary.

claimed.

Filing on Behalf of a Living Owner

2. through 6. Print the original property owner’s

Provide a copy of the certified Power of Attorney

name, address and property information as listed on

showing your authority to file on their behalf. If the

the web page.

owner is a minor, provide a copy of the birth

certificate.

B. CLAIMANT INFORMATION

Filing on Behalf of a Business

Provide proof of authority to file this claim. A copy of

1. through 5. Print your name and current mailing

a business license or letterhead showing the

address. For additional claimants attach names and

address reported to our office and a copy of Articles

addresses to the claim form. NOTE: checks cannot

of Incorporation must also be provided.

be mailed to a Post Office Box number. Please

include a street address in 2. Mailing address.

PROOF OF ADDRESS

6. Print your daytime or message phone number.

Provide documentation showing the original address

7. If you are a company, print your federal

printed in BoxA4. If the address is Unknown, you

tax ID number. If you are an individual(s),

must prove a business relationship with the

print your social security number. This

company that reported the property to the state.

information is required to issue a state check

Below are examples to help prove the address or

and/or transfer securities into your name

business relationship:

8. Check whether or not you are the original owner.

•

Auto registration

9. Provide your relationship to the original owner if

•

College Transcript

your response to #8 was no.

•

Marriage Certificate

•

Utility Statement

C. PROOF OF OWNERSHIP

•

Bank Statement

•

Court Documents

PROOF OF IDENTITY

•

Medical Card

Filing as an Original Owner

•

Insurance Policy

Provide a photocopy of your current driver’s license

•

Birth Certificate

or a clear copy of other legal photo identification. If

•

Divorce Decree

your name has changed then provide proof of the

•

Expired Driver’s License or ID Card

change. Provide a photocopy of your Social

•

Stock Certificate

Security card or a document with you Social Security

•

Canceled Check

number on it. All data submitted on this form are

•

Income Tax Return

considered public except your social security

•

Report Card

number. The Department of Commerce collects

•

Pay Stub

your social security number to identify you and

•

Postmarked Envelope Addressed to You

comply with Minnesota tax law, including Minn.

•

W-2

Stat. §270.66. Providing your social security

number with this claim is mandatory. Without it,

If you cannot provide documentation as requested,

your claim will be denied. It will be sent to the

please attach a letter explaining why you are entitled to

Minnesota Department of Finance and

this property or any special circumstances that may

Department of Revenue. If you owe delinquent

apply to this claim.

taxes to Minnesota, that amount may be

deducted from the money owed you on this

D. AFFIDAVIT

claim. We require proof of identity fom all claimants.

We are unable to pay claims based on name

This section must provide the claimant’s legally

similarity alone; sufficient proof is required.

notarized signature, which will serve as verification of the

Filing with Multiple Owners

information provided on this form.

Proof of identity must be provided for each person

filing the claim. See the section above, “Filing as an

Your claim will be processed in 90 days. If you

Original Owner,” for each person’s proof

haven’t heard from us after 90 days, please

requirements.

Claim Form - Minnesota Department Of Commerce

Related Articles

Related forms

Related Categories