Form Ipnr-Ii A (E) - Addendum To Initial Report On Abandoned Or Unclaimed Money And Other Liquid Goods

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Commonwealth of Puerto Rico
Addendum to Initial Report on Abandoned or Unclaimed Money
Office of the
and Other Liquid Goods as of June 30, 20___
OFFICIAL
Commissioner of Financial Institutions
(Filing required only from holders regulated, supervised or licensed by the OCIF)
USE ONLY
Unclaimed Property Division
Holder:
PO Box 11855
Mailing Address:
Holder
San Juan, Puerto Rico 00910-3855
Report
Receipt
Contact:
Tel:
FILING DEADLINE: AUGUST 10
ALL HOLDERS MUST FILE FINAL DECEMBER 10 REPORT
Date
Owner's Last Name, First Name
Owner's Social
Identifying
Property
Amount Due
Date of Last
Street Address
Security Number
Number
Type Code
Owner
Transaction
City, State, Zip Code
or FEIN
(1)
(2)
(3)
(4)
(5)
(6)
Please attach to Inicial Report {Form IPNR-II (E)}
Page ____ of ____
IPNR - II A (E), revised in October, 2003

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