Form 496-Up - Report Of Unclaimed Report - Verification And Checklist - 2017
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2Form Number 496-UP -Revision
OKLAHOMA STATE TREASURER UNCLAIMED PROPERTY DIVISION
REPORT OF UNCLAIMED REPORT – VERIFICATION AND CHECKLIST
Verification for Period Ended _____06/30__________, _2017
Provide the name of the holder company reporting for the period indicated. List the prior name(s), FEI(s), or address(es) if the company has had a
change in these items during the time period in which it has held the property being reported.
Name ________________________________________________________
State of Incorporation______________________________________
_____________________________________________________________
Date of Incorporation _______________________________________
Address ______________________________________________________
Federal Employer ID#_______________________________________
_____________________________________________________________
Every person, corporation, or other business association, banking or financial organization, life insurance corporation, utility, court or public authority
must complete the following checklist before filing their Oklahoma Unclaimed Property Report. This checklist includes by way of illustration, but not
limitation, those items which are covered by Sections of the Oklahoma Unclaimed Property Law.
Please complete the checklist by indicating the items being reported. A “Yes” must be enumerated on Unclaimed Property Form 497-UP-2.
Property Type Codes and Abandonment Periods
Account Balances Due
Yes No
Code Description
Yr
Yes
No
Code
Description
Yr
___ ___ AC01
Checking Accounts
5
___ ___
AC06
Security Deposits
5
___ ___ AC02
Savings Accounts
5
___ ___
AC07
Unidentified Deposits
5
___ ___ AC03
Matured CD or Saving Certificate
5
___ ___
AC08
Suspense Accounts
5
___ ___ AC04
Christmas Club Funds
5
___ ___
AC99
Aggregate Account Balances
5
___ ___ AC05
Money on Deposit to Secure Fund
5
Court Deposits
___ ___ CT01
Escrow Funds
1
___ ___
CT04
Suspense Accounts
1
___ ___ CT02
Condemnation Awards
1
___ ___
CT05
Other Court Deposits
1
___ ___ CT03
Missing Heirs’ Funds
1
___ ___
CT99
Aggregate Court Deposits
1
Education Savings Plan
___ ___ CS01
Savings Accounts – Cash
5
___ ___
C02
Savings Account – Mutual Fund
5
___ ___ CS03
Savings Accounts - Securities
5
Health Savings Plan
___ ___ HS01
Health Savings Account
5
___ ___
HS02
Suspense Accounts
5
Insurance
___ ___ IN01 Individual Policy Benefits or Claim Payments
5
___ ___
IN06
Unidentified Remittances
5
___ ___ IN02 Group Policy Benefits or Claim Payment
5
___ ___
IN07
Other Amounts Due Under Policy Terms
5
___ ___ IN03 Proceeds Due Beneficiaries
5
___ ___
IN08
Agent Credit Balances
5
___ ___ IN04 Proceeds from Matured Policies,
5
___ ___
IN09
Proceeds from Demutualization
2
Endowments, or Annuities
___ ___
IN10
Shares of Stock from Demutualization
2
___ ___ IN05 Premium Refunds
5
___ ___
IN99
Aggregate Insurance Property
5
IRA’S (TRADITIONAL/ROTH)
___ ___ IR01 Traditional IRA – Cash
7**
___
___
IR05
Roth IRA – Cash
7**
___ ___ IR02 Traditional IRA – Mutual Fund
7**
___
___
IR06
Roth IRA– Mutual Funds
7**
___ ___ IR03 Traditional IRA – Securities
7**
___
___
IR07
Roth IRA– Securities
7**
** IRA’s are reportable 7 years after the participant has attained the age of 70 1/2.
Mineral Proceeds and Mineral Interests
___ ___ MI01
Net Revenue Interest
5
___ ___
MI06
Bonuses
5
___ ___ MI02
Royalties
5
___ ___
MI07
Delay Rentals
5
___ ___ MI03
Overriding Royalties
5
___ ___
MI08
Shut-In Royalties
5
___ ___ MI04
Production Payments
___ ___
MI09
Minimum Royalties
5
___ ___ MI05
Working Interest
5
Miscellaneous Checks and Intangible Personal Property
___ ___ MS01
Wages, Payroll, and Salary
1
___ ___
MS11
Refunds Due
5
___ ___ MS02
Commissions
5
___ ___
MS12
Unredeemed Gift Certificates
5
___ ___ MS03
Worker’s Compensation Benefits
5
___ ___
MS13
Unclaimed Loan Collateral
5
___ ___ MS04
Payment for Goods and Services
5
___ ___
MS14
Pension & Profit Sharing Plans
7**
___ ___ MS05
Customer Overpayments
5
___ ___
MS15
Dissolution or Liquidation
1
___ ___ MS06
Unidentified Remittances
5
___ ___
MS16
Misc Outstanding Checks
5
___ ___ MS07
Un-refunded Overcharges
5
___ ___
MS17
Misc Intangible
5
___ ___ MS08
Accounts Payable
5
___ ___
MS18
Suspense Liabilities
5
___ ___ MS09
Credit Balance - Accounts Receivable
5
___ ___
MS99
Aggregate Misc Property
5
___ ___ MS10
Discounts Due
5
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