Form Dfs-Up-155 - Safe Deposit Box Inventory Form Of Property Presumed Unclaimed (Page 2 of 4) in pdf

OWNER’S NAME_____________________________________________________ SAFE DEPOSIT BOX # _______________________ PAGE________ OF________

Y/M = Yellow Metal

CONVERT ALL FACE VALUE MONIES TO CHECK PAYABLE TO:

W/M = White/Silver Colored Metal

DEPARTMENT OF FINANCIAL SERVICES

SB 08-NUMISMATIC

QTY

SBO1-JEWELRY

QTY

SB 13-US GOLD

QTY

US BILLS

Y/M NECKLACE(S)

U.S. PROOF / MINT SET (S)

U.S. $10,000.00 BILL(S)

Y/M NECKLACE W/PENDANT(S)

TOTAL OF COINS IN SETS

U.S. $1,000.00 BILL(S)

Y/M NECKLACE W/STONE(S)

U.S. $50.00 GOLD COIN (S)

U.S. $500.00 BILL(S)

NECKLACE W/PEARL-LIKE BEADS

U.S. $20.00 GOLD COIN (S)

U.S. $100.00 BILL(S)

Y/M RING(S)

U.S. $10.00 GOLD COIN (S)

U.S. $50.00 BILL(S)

Y/M RING W/STONE(S)

U.S. $5.00 GOLD COIN (S)

U.S. $20.00 BILL(S)

Y/M RING W/BEAD(S)

U.S. $2-1/2 GOLD COIN (S)

U.S. $10.00 BILL(S)

Y/M BRACELET(S)

U.S. $1.00 GOLD COIN (s)

U.S. $5.00 BILL(S)

Y/M BRACELET W/STONE(S)

U.S. GOLD PROOF/MINT SET (S)

U.S. $2.00 BILL(S)

Y/M BRACELET W/CHARM(S)

TOTAL # OF COINS (IN SET)

U.S. $1.00 BILL(S)

BRACELET W/PEARL-LIKE BEAD(S)

U.S. PLATINUM COIN (S)

SB 08-CONFEDERATE

QTY

Y/M PIN / BROOCH(S)

STATES PAPER MONEY

Y/M PIN / BROOCH W/STONE(S)

QTY

SB 03-NUMISMATIC COINS

CONFEDERATE $1000 BILL(S)

Y/M PIN / BROOCH W/BEAD(S)

U.S. COINS & COIN BOOKS

CONFEDERATE $500 BILL(S)

Y/M CHARM / PENDANT(S)

U.S. 1-DOLLAR COIN(S) LOOSE

CONFEDERATE $100 BILL(S)

Y/M PAIR OF CUFFLINKS

U.S. 1-DOLLAR ROLL(S)

CONFEDERATE $50.00 BILL(S)

Y/M SINGLE CUFFLINK(S)

U.S. 1-DOLLAR PARTIAL ROLL(S)

CONFEDERATE $20.00 BILL(S)

Y/M CAMEO STYLE PIN/PENDANT

U.S. 1-DOLLAR COIN BOOK(S)

CONFEDERATE $10.00 BILL(S)

W/M CAMEO STYLE PIN/PENDANT

TOTAL # OF COINS IN BOOKS

CONFEDERATE $5.00 BILL(S)

Y/M PAIR OF EARRINGS

CONFEDERATE $ 2.00 BILL(S)

Y/M PAIRS EARRINGS W/STONE(S)

U.S. 50-CENT COIN (S) LOOSE

CONFEDERATE $1.00 BILL(S)

Y/M SINGLE EARRING(S)

U.S. 50 CENT COIN ROLL (S)

Y/M SINGLE EARRING W/STONE(S)

U.S. 50 CENT PARTIAL ROLL (S)

GEM STONE(S)

U.S. 50-CENT COIN BOOK (S)

SB 09-FOREIGN PAPER

QTY

W/M NECKLACE(S)

TOTAL # OF COINS IN BOOKS

CURRENCY

W/M NECKLACE W/PENDANT(S)

W/M NECKLACE W/STONE(S)

U.S. 25-CENT COIN (S) LOOSE

QTY

SB 10-FOREIGN COIN(S)

W/M RING(S)

U.S. QUARTER ROLL (S)

W/M RING W/STONE(S)

U.S. QUARTER PARTIAL ROLL(S)

W/M BRACELET(S)

U.S. 25-CENT COIN BOOK (S)

SB 14-FOREIGN GOLD

QTY

W/M BRACELET W/STONE(S)

TOTAL # OF COINS IN BOOKS

COIN(S)

W/M BRACELET W/CHARM(S)

W/M PIN / BROOCH(S)

U.S. 10-CENT COIN (S) LOOSE

W/M PIN/BROOCH W/STONE(S)

U.S. 10-CENT COIN ROLL (S)

SB 15-FACE VALUE

QTY

W/M CHARM/PENDANT(S)

U.S. 10-CENT PARTIAL ROLL (S)

MONIES

W/M SINGLE CUFFLINK(S)

U.S. 10-CENT COIN BOOK (S)

$100.00 BILL(S) F/V

W/M PAIR OF CUFFLINK(S)

TOTAL # OF COINS IN BOOKS

$50.00 BILL(S) F/V

W/M PAIR OF EARRINGS

$20.00 BILL(S) F/V

W/M PAIR EARRINGS W/STONE(S)

U.S. 5-CENT COIN (S) LOOSE

$10.00 BILL(S) F/V

W/M SINGLE EARRING(S)

U.S. 5-CENT COIN ROLL (S)

$5.00 BILL(S) F/V

W/M SINGLE EARRING W/STONE(S)

U.S. 5-CENT PARTIAL ROLL (S)

$1.00 BILLS F/V (S)

MISC. JEWELRY PIECE(S)

U.S. 5-CENT COIN BOOK (S)

$0.50 CENT COIN(S) F/V

EARRING BACK(S), CLASP(S), ETC

TOTAL # OF COINS IN BOOKS

$0.25 CENT COIN(S) F/V

TIE TACK(S) & TIE CLIP(S)

$0.10 CENT COIN(S) F/V

TUXEDO BUTTON(S)/STUD(S)

U.S. 1-CENT(S) (PENNY)

$0.05 CENT COIN(S) F/V

MISC PIN(S)

U.S. 1-CENT PENNY ROLL(S)

$0.01 CENT COIN(S) F/V

MISC NECKLACE(S)

U.S. 1-CENT PARTIAL ROLL(S)

CONVERT TO CHECK

MISC BRACELET(S)

U.S. 1-CENT PENNY BOOK(S)

TOTAL # OF COINS IN BOOKS

Form Dfs-Up-155 - Safe Deposit Box Inventory Form Of Property Presumed Unclaimed Page 2

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