Unclaimed Property Annual Compliance Report Cover Sheet Page 2
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1
2Office of the Vermont State Treasurer – Unclaimed Property Division
th
109 State St., 4
Floor │Montpelier, VT 05609-6200 │ Phone: 802.828.2407 • Fax: 802.828.2884
U
P
A
C
R
NCLAIMED
ROPERTY
NNUAL
OMPLIANCE
EPORT
V
C
L
ERIFICATION
HECK
IST
Holder Name
Verification for the Period Ended
Every person, corporation or other business association, banking or financial organization, life insurance corporation, utility, court, or public
authority must complete this Verification Check List as part of the annual reporting of unclaimed property.
This checklist illustrates, without limitation, those items covered by Chapter 14, Title 27 of the Vermont Statutes. With the exception of travelers
checks and money orders, the property types shown below must be reported if unclaimed for one or more years. Travelers checks should be held
fifteen (15) years and money orders seven (7) years. Check the box next to each applicable item. Each checked item must be accounted for on
the detail of the Annual Report of Unclaimed Property.
A
B
P
, E
, M
. C
I
P
CCOUNT
ALANCES
AYROLL
XPENSE
ISC
HECKS AND
NTANGIBLE
ERSONAL
P
H
O
B
ROPERTY
ELD IN COURSE OF
RDINARY
USINESS
Checking accounts
Savings accounts
Wages, payroll or salary
Matured certificates of deposit or savings certificates
Commissions
Christmas Club accounts
Expense checks
Worker’s Compensation benefits
Money on deposit to secure funds
Security deposits
Pension checks
Unidentified deposits
Credit checks or memos
Suspense accounts
Payments for goods and services
Sums owing to a shareholder, certificate holder, bond holder or other
Customer overpayments
security holder, or participating member of a cooperative, such as:
Unidentified remittance
dividends
Un-refunded overcharges
interest
Accounts payable
principal payments
Credit balances - accounts receivable
equity payments
Discounts due
profits
Refunds
other distributions
Unredeemed gift certificates
Escrow funds
Vendor Checks
Mineral proceeds
Royalties
C
D
OURT
EPOSITS
Escrow funds
Any other miscellaneous outstanding checks
Condemnation awards
Any checks written off to income or surplus
Missing heir funds
Any other miscellaneous intangible personal property
Suspense accounts
Victim’s restitution
T
P
ANGIBLE
ROPERTY
Any other type of deposit made with a court or public authority
Safe deposit box contents
Any other safekeeping repository contents
D
Other tangible property
ISSOLUTIONS
Property distributable in the course of voluntary or involuntary
dissolution or liquidation which is unclaimed within one year after the
T
, I
E
A
RUST
NVESTMENT AND
SCROW
CCOUNTS
date for final distribution is presumed abandoned.
Paying agent accounts
Unclaimed dividends
Funds held in a fiduciary capacity
I
NSURANCE
Amounts due and payable under terms of insurance policies
Funds paid toward the purchase of shares, or interest in a
Claim payments
financial or business organization
Drafts not presented for payment
Funds received for redemption of stocks and bonds
Matured whole life, term or endowment insurance policies or annuity
Stocks
or supplementary contracts
Bonds
Other amounts due under policy terms
Any other certificates of ownership
Suspense liabilities
O
C
FFICIAL
HECKS
Certified checks
U
TILITIES
Cashier’s checks
Utility deposits
Registered checks
Membership fees
Treasurer’s checks
Refunds or rebates
Drafts
Warrants
Money orders
Travelers checks
Foreign exchange
Other official checks or exchange items
Rev: 10.12.16
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