Form Ouf-5 - List Of Owners Of Safe Deposit Box Contents And Safekeeping - Ohio Division Of Unclaimed Funds
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1
2OHIO DIVISION OF UNCLAIMED FUNDS
Page No. _______ of _______
OUF-5 LIST OF OWNERS OF SAFE DEPOSIT BOX CONTENTS AND SAFEKEEPING
COMPANY NAME
FEIN OR SSN
SAFE DEPOSIT BOX NO.
DATE OF LAST LEASE PMT
DATE FORCED OPEN
REPORT YEAR
DESCRIPTION
DATE OF BIRTH
LASTNAME OR BUSINESS NAME
FIRST NAME
INTIAL
SSN OR FEIN
STREET ADDRESS:
RELATIONSHIP CODE
STREET ADDRESS:
CITY
STATE
ZIPCODE
DESCRIPTION
DATE OF BIRTH
LASTNAME OR BUSINESS NAME
FIRST NAME
INTIAL
SSN OR FEIN
STREET ADDRESS:
RELATIONSHIP CODE
STREET ADDRESS:
CITY
STATE
ZIPCODE
NATURE OF
NUMBER OF
OFFICE USE
DESCRIPTION OF THE CONTENTS
FUNDS CODE
ITEMS
ONLY
Use the Back of this Form To List Additional Unclaimed Items
Group like items during the inventory process and provide the following for each item or group:
Nature of Funds Code: Enter the Nature of Funds Code corresponding to the description of funds. The Nature of Funds Codes and
descriptions are listed on page 26 of this booklet.
Number of Items: En te r the number of items for this item or group of items remitted. C oin s should be wrapp e d a ccording to
denomination or placed in appropriate containers.
Description of the Contents: Enter a description that best describes the unclaimed safe deposit box contents remitted If
rep o rtin g stock i n clude th e regi ste red own er's nam e , i ssui ng compa n y an d num be r of sha res
Joint Accounts or Accounts with Multiple Relationships: List the name and address information for each owner separately in the two
(2) owner information blocks provided. If the box has more that two (2) owners please attach a separate sheet with their name and address
information.
COM 5520 revised 5/2004
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