Form Ipnr - Ifb A - Addendum To Final Report On Unclaimed Amounts - Commonwealth Of Puerto Rico

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Commonwealth of Puerto Rico
Addendum to Final Report on Unclaimed Amounts
Office of the
as of June 30, 20
OFFICIAL
Commissioner of Financial Institutions
Please attach to Form IPNR-IFB (E) *
USE ONLY
Unclaimed Property Division
Holder:
PO Box 11855
Mailing Address:
Holder
San Juan, Puerto Rico 00910-3855
Report
Receipt
Contact:
Tel:
FILING DEADLINE: DECEMBER 10
PUBLICATION COST: $_______________
Date
Owner's Last Name, First Name
Owner's Social
Identifying
Property
Amount Due
Date of Last
Street Address
Security Number
Number
Type Code
Owner
Transaction
City, State, Zip Code
or FEIN
(5)
(6)
(1)
(2)
(3)
(4)
Page
of
IPNR - IFB A (E), revised in July, 2011
* Electronic filing is also required, if more than 25 records are reported

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