Form Up-6 - Holder Report Publisher - Idaho State Treasurer
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1IDAHO STATE TREASURER • UNCLAIMED PROPERTY
SAFEKEEPING INVENTORY
Holder Name___________________________________________ Holder ID #_____________________
Owner Name(s)_______________________________________ SS#/FEIN/TIN_____________________
Street Address_________________________________________________________________________
City, State, ZIP__________________________________ Box#/Patient#/Other#____________________
On this_____________ day of ____________________, 20______, the contents listed were removed, securely wrapped and the
package plainly marked with the name(s) of the owner(s) and placed in joint custody.
Branch Employee _____________________________________
Branch Manager _____________________________________
No. of items
Description of Contents
Officer’s Initials
Notary’s Initials
Sworn to and subscribed before me
this
I, _________________________________ a duly authorized representative of the holder listed
above, do hereby certify that the above listed items described are contained in the package
delivered by the holder. I agree, upon delivery of the above-described property, to indemnify the
__________day of ___________, 20 _____
State and hold it harmless from all claims and loss, demands, costs, and other expenses.
Notary: ____________________________
Name and Title of Holder Representative (type/print) ___________________________
My commission expires: _______________
Signature of Holder Representative ________________________________________
Date______________
UP-6 (04/17/13)
34
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Parent category: Financial