Unclaimed Nclaimed Property - Reporting Booklet - Washington Department Of Revenue Page 15
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28INSTRUCTIONS FOR COMPLETING SAFE
DEPOSIT BOX REPORT FORM REV 80 0002-1
When to report:
This form is used to report safe
ITEM 1:
Enter the owner’s safe deposit box number
deposit boxes only. It is to be completed and mailed
or safekeeping number where contents were held.
with the Summary Report REV 80 0004-1.
ITEM 2:
Enter the full name (last name first) of the
When to remit:
DO NOT send safe deposit box
owner of the safe deposit box.
contents with the November report. The Department
will notify you in writing of its decision to “accept” or
a)
List last name, full first name and full middle name, if
“reject” each of the safe deposit boxes reported.
available, on the appropriate lines. Be sure to in-
Included with your “accept/reject” letter will be a
clude information which would aid in identification
scheduled delivery date and instructions on method of
such as Jr., Sr., Miss, Mrs., etc., after the middle
shipment. All boxes “accepted” are to be sent in their
name (for example, Smith, Jane Ann, Mrs.)
entirety. All coins and cash must be sent intact. No
b)Corporate titles and the like should be entered ex-
bank check substitutions for cash or coins are permit-
actly as adopted except that the word “The” should
ted. A photocopy of
be omitted when it is the first word in the title.
this report is to be
c)If a single safe deposit box has two owners, the names
sent along with the
of both must be shown along with the relationship
“accepted” contents
(for example, “trustee for”, “or”, “and”, etc.)
at remittance time.
ITEM 3:
Enter the owner’s social security number.
Please type or legibly print your report.
ITEM 4:
Enter the last known address of the owner
A. HOLDER:
Enter the holder’s name and address
of the safe deposit box. If a single safe deposit box
exactly as it appears (after corrections, if any)
has two or more owners, the addresses of both must
on the Summary Report for Unclaimed Property.
be shown. If all owners have the same address, the
address may be entered once.
B. HOLDER NUMBER:
Enter the Washington
State unclaimed property holder number as
ITEM 5:
Enter the date the rental period expired on
signed to you, if known. Use this number on all
the safe deposit box, or in the case of safe keeping
related correspondence.
items, the date of the last positive contact with the
owner.
C. REPORT YEAR:
Enter the year for which the
report is being filed.
ITEM 6:
Enter the name of the bank branch location
where property was held. List the complete address
D. PERIOD COVERED:
Enter the period covered
including the zip code.
for this report.
ITEM 7:
Enter the amounts still owing to the holder.
Page:
Enter the page number of the report (for
These amounts might include unpaid safe deposit box
example, 1 of 2.)
rental charges, drilling fees, safekeeping costs,
certified mailing costs, etc. Do not deduct any of
All shaded areas are for Department use only.
these costs from any cash which may be in the box at
this time. Holders will be reimbursed by the State for
Unclaimed Property Reporting Booklet
15
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