Notice Of Escheat Property Form (Page 2 of 2) in pdf

Notice Of Escheat Property Form Page 2

For Department Use Only:

The Estate Tax Examiner of the Miscellaneous Tax Section of the Washington State Department of Revenue hereby:



Elects to serve a personal representative and designates the following to represent the Department, with petition for

appointment to be made in the near future:

Name ___________________________________________________________________________________

Address __________________________________________________________________________________

City, State, and Zip Code ____________________________________________________________________

Phone ___________________________________________________________________________________



Declines to serve as personal representative under Chapter 11.28 RCW. Please note, the Department’s waiver to serve

under Chapter 11.28 does not, in any way effect the provisions of Chapter 11.08 RCW which provides for specific

notation during the administration of an escheat and the ultimate conveyance of the escheated property to the

Department of Revenue for the benefit of the common school fund.

Copies of letters of administration issued in this estate must be forwarded to the Department of Revenue, P.O. Box

47488, Olympia, WA 98504-7488. Failure to comply with the provisions of Chapter 11.08 RCW in respect to

notification to the Department will result in any orders being void for lack of jurisdiction.

Signed _____________________________________________

Estate Tax Examiner

Miscellaneous Tax Section

Washington State Department of Revenue

REV 85 0030 (6/22/11)

Notice Of Escheat Property Form Page 2