Unclaimed Nclaimed Property - Reporting Booklet - Washington Department Of Revenue Page 7
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28INSTRUCTIONS FOR COMPLETING
SUMMARY REPORT FORM REV 80 0004-1
Primary Business Activity
Briefly describe your primary business activity.
Contact Person
Complete this section only if there is a change in
telephone number or contact person. Enter the
name and telephone number of the person most
familiar with the details of the report. This person
may be contacted should any questions arise
concerning the report.
Negative report
By checking this box you are indicating that you
have nothing to report for the current report year.
Final report
Holder Reporting Number, Name and Address
If the company has closed or merged with another
Please place the address label from the back cover of
and the account should be closed please indicate
this packet in this area. This address will be used for
this by checking this box.
any future reports or correspondence regarding
unclaimed property.
Reporting Media
Please provide the requested information next to
Name or Address Change
the type of media being submitted.
If the address on the label is incorrect, enter the
correct address in the space provided. Please note
Summary of Property Reported
any name changes, mergers, and/or listing of subsid-
First complete the detail report(s) for unclaimed
iaries that may be reporting under the same holder
property. Then summarize the totals for each
name.
property type by indicating the category code and
the total amount for the particular property type.
Federal ID Number
A listing of codes for the different property types
Enter your nine digit federal identification number.
is found on page 23.
Report Year
Report Declaration
Enter the year for which the report is being filed.
The report must be signed by an authorized indi-
vidual.
Date and State of Incorporation
Enter your state of incorporation and the date incor-
porated.
SIC Code
Please enter your company’s Standard Industrial
Code (if known).
Unclaimed Property Reporting Booklet
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