MARK GORDON
STATE TREASURER
WYOMING STATE TREASURER’S OFFICE
REPORT OF UNCLAIMED PROPERTY
UNCLAIMED PROPERTY DIVISION
WUP-1 VERIFICATION
Verification for Period Ended June 30, 20__
HOLDER INFORMATION:
Federal Employer’s ID Number: _________________
Name: __________________________________________________________
Address: ________________________________________________________
City/State/Zip: ___________________________________________________
State of Incorporation: _____
Date of Incorporation/Charter Date: ______________
Contact Person for Reporting: _______________________________________
Telephone Number: ____________________________
Email Address: _______________________________
Mailing Address: _________________________________________________
_________________________________________________
Are the following included in your report:
Stocks
Mutual Funds
Safe Deposit Box
I, _________________________________, being first duly sworn, on oath depose and state that I, an
authorized party, have caused to be prepared and have examined this report, including the property detail
consisting of __________ items totaling $_________________________ and/or _________________ shares
as to property presumed unclaimed under the Wyoming Uniform Unclaimed Property Act for the year ending
as stated; that I am duly authorized by the holder herein to execute this report; and I believe that said report is
true, correct and complete as of said date, excepting for such property as has since ceased to be unclaimed.
Signature: ______________________________________________________
Typed Name: ____________________________________________________
Title: __________________________________________________________
Mailing Address:
Physical, Fedex, UPS Address:
Wyoming State Treasurer
Wyoming State Treasurer
Unclaimed Property Division
Unclaimed Property Division
th
200 West 24
Street
2020 Carey Ave, 3rd Floor
Cheyenne, Wyoming 82002
Cheyenne, Wyoming 82002
Updated 10.16