Unclaimed Property Claimant Form












If you are claiming funds on behalf of another person or entity, complete the following.





By stating that funds are to be reissued, I am claiming a legal ownership interest, on behalf of myself, someone else, or the company identified above, in the funds as described above. I have included a copy of my driver’s license, title, company, as well as any additional supporting proof of ownership. Further, if at a later time, additional information is located to confirm the funds being reissued has been previously received, I, on behalf of the party requesting payment, agree to indemnify the payor for this amount.


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