Fillable Form Abp-10 - Ma Unclaimed Property Division - Ma Abandoned Property Division printable pdf download

Form Abp-10 - Ma Unclaimed Property Division - Ma Abandoned Property Division

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COMMONWEALTH OF MASSACHUSETTS

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OFFICE OF THE STATE TREASURER & RECEIVER

GENERAL UNCLAIMED PROPERTY DIVISION

One Ashburton Place, 12th Floor

Boston, MA 02108-1608

(617) 367-0400 or 1-800-647-2300 (toll free Massachusetts only)

Return Name:

Address:

Inquiry Number:

City:

State:

Zip:

Date

Form ABP-10

The division received under General Laws, Chapter 200A, the Unclaimed Property Law, an amount of money which was

standing to the credit of the deceased

(Name of Deceased)

What is your relationship to the decedent?

CHECK ONE OF THE FOLLOWING, IF 2 IS CHECKED COMPLETE 2a

Swear and attest under the pains and penalties of perjury that I am the

person entitled to the return of the paid amount as the only person holding

a legal or equitable interest therein.

Signature

Swear and attest under the pains and penalties of perjury that I have

notified all other persons holding a legal and equitable interest in the

said amount and they have authorized me to act on their behalf as ascribed below.

Signature

2a) We the undersigned hereby assent to the release of said property to

By the Massachusetts State Treasurers Office of Unclaimed Property.

Claimant Name:

2nd Claimant Name

(if applicable):

3rd Applicant Name if applicable:

In consideration of the payment to me of said amount less costs and expenses provided by the law, I agree to indemnify the Commonwealth of Massachusetts

and hold it harmless for and from all claims and loss, costs, damages, and expenses which the said Commonwealth of Massachusetts may sustain by reason of

the turning over of said amount to me and by reason further of it's refusal hereafter to pay the said amount or any part thereof to any other person or persons.

Further, I swear and attest that all claims, assertions and signatures made above are true.

Claimant Signature - Witnessed by a Notary Public

NOTARY USE ONLY

Subscribed and Sworn before me, this_______day of_______________________20_____ a Notary Public in and for the County of _____________________ in

the State of ___________________________________.

(Affix Seal Here)

My Commission Expires

______________20___

(Signature of the Notary)

(Name of Notary - Please Print)