Form Up-3a - Safe Deposit Box Or Other Safekeeping Repository Owner Information (Page 5 of 5) in pdf

Form Up-3a - Safe Deposit Box Or Other Safekeeping Repository Owner Information Page 5

OWNER PAGE INSTRUCTIONS - UP3A

(Omit all Punctuation)

Enter the holder name and branch location.

HOLDER/BRANCH:

Number pages of report 1 of 100, 2 of 100, etc.

PAGE NUMBER:

PROPERTY CODE:

The (Safety Deposit Code) SD01-safe deposit contents, SD02-other

safekeeping repositories, SD03-other tangible property.

The number of the Safe Deposit Box/Unit that was assigned by the holder.

OWNER BOX/UNIT #:

The date the property was considered abandoned, which is 5 years after the

ABANDONED:

owner’s failure to pay rents due.

HOLDER CHARGES:

Lien Charges; means the amount due to the holder for rental to the time of

removal of contents, and costs of opening, repairing, and restoration.

The number of the storage box that contains the box/unit (state use only).

STORAGE BOX NUMBER:

Box/unit owner’s last name.

OWNER LAST NAME:

FIRST NAME:

Owner’s first name.

Owner’s middle initial.

MI:

The owner is a Jr., Sr., etc.

SUFFIX:

OWNER SS#/FID #:

Box/unit owner’s social security number. If company, federal identification

number.

Input number of box/unit owners.

NO. OF OWNERS:

Input complete account title (example: and/or, custodian, Mr/Mrs)

TITLE/OTHER:

ADDRESS 1:

Street address of the owner.

This is to continue the owner’s address if needed. Include building number

ADDRESS 2:

or any additional information.

City of the owner’s address.

CITY:

STATE:

State of the owner.

Zip code of the owner.

ZIP:

Country of residence of the owner, if other than United States of America.

COUNTRY:

COMMENTS:

Space to add any additional, relevant information not covered in previous

fields.

Select a category number from the provided category list.

CATEGORY #:

Select a sub-category from the provided category list. If not found, input

SUB-CATEGORY:

other with the closest category.

QUANTITY:

Number of items.

Detail the individual item with any pertinent information.

DESCRIPTION OF ITEM:

ESTIMATED VALUE:

Each individual item must list an estimated value.

Form Up-3a - Safe Deposit Box Or Other Safekeeping Repository Owner Information Page 5

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