Form Dfs-Up-155 - Safe Deposit Box Inventory Form Of Property Presumed Unclaimed
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4DEPARTMENT OF FINANCIAL SERVICES
Division of Accounting and Auditing – Bureau of Unclaimed Property
SAFE DEPOSIT BOX INVENTORY FORM OF PROPERTY PRESUMED UNCLAIMED
IMPORTANT: MARK SHIPPING CARTON “DELIVER UNOPENED”
Mail Contents to:
State of Florida
Department of Financial Services
Bureau of Unclaimed Property
200 East Gaines Street
Tallahassee, FL 32399-0360
Unclaimed Property Identification Number (UPID) (From DFS-UP-111 Cover Sheet) __________________________________
Federal Tax Identification Number (FEID) _____________________________________ Branch #________________________
Branch Location/Address__________________________________________________________________________________
Owner’s Name____________________________________________________________________________________________
Owner’s Address_________________________________________________________________________________________
Safe Deposit Box #_________________________________ Date Drilled ________________ Rent Due $ _________________
Drilling Fee $______________ Prepared By ___________________________________ Date Prepared __________________
Operations Officer____________________________________________________ Date Prepared_______________________
Date Claimed By Owner______________________ Owner’s Signature_____________________________________________
Witnessed By_______________________________________________________ Date________________________________
Form DFS-UP-155, Revised 12/27/2012
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