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Get Alabama Unclaimed Money Form

REPORT FORM 1 KAY IVEY STATE TREASURER UNCLAIMED PROPERTY DIVISION P. O. Box 302520 Montgomery AL 36130-2520 334 242-9614 Toll Free 1-888-844-8400 Fax 334 242-9620 s Check here if negative report PART I Business Information REPORT DATE FOR PERIOD ENDING REPORT YEAR FEIN CHECK NUMBER TOTAL REMITTED AMOUNT NUMBER OF PAGES NUMBER OF OWNERS / RECORDS REPORTED REPORT TOTAL SHARES TOTAL REPORTED SAFE DEPOSIT BOXES COMMENTS THIS REPORT INCLUDES All Branches and Divisions All Subsidiaries Only This Company/Branch/Division NAME OF BUSINESS STATE OF INCORPORATION MAILING ADDRESS ADDRESS CONT D. STANDARD INDUSTRIAL CLASSIFICATION CODE CITY STATE ZIP COUNTY PART II Previous Business Name If held in other name during the Report Year list the name and address NAME OF PREVIOUS BUSINESS PREVIOUS FEIN ADDRESS STREET CITY STATE ZIP PART III Primary Business Activity Information IS THE HOLDER A Subsidiary Wholly Owned A Division NAME OF PARENT COMPANY Publicly Traded Private Government Entity PARENT FEIN PART IV Contact Information CONTACT PERSON TITLE TELEPHONE NUMBER EXTENSION FAX NUMBER PART V Affidavit State of County of I do hereby certify the following as of the date my signature is notarized below 1 I am duly authorized to execute this report and make the following representations on behalf of the holder listed above. 2 Said holder has performed due diligence as required by Section 35-12-31 e Code of Alabama 1975. 3 To the best of my knowledge this report is an accurate and complete account of all property in the Holder s custody which is presumed abandoned under the Alabama Unclaimed Property Act. REPORT FORM 1 KAY IVEY STATE TREASURER UNCLAIMED PROPERTY DIVISION P. O. Box 302520 Montgomery AL 36130-2520 334 242-9614 Toll Free 1-888-844-8400 Fax 334 242-9620 s Check here if negative report PART I Business Information REPORT DATE FOR PERIOD ENDING REPORT YEAR FEIN CHECK NUMBER TOTAL REMITTED AMOUNT NUMBER OF PAGES NUMBER OF OWNERS / RECORDS REPORTED REPORT TOTAL SHARES TOTAL REPORTED SAFE DEPOSIT BOXES COMMENTS THIS REPORT INCLUDES All Branches and Divisions All Subsidiaries Only This Company/Branch/Division NAME OF BUSINESS STATE OF INCORPORATION MAILING ADDRESS ADDRESS CONT D. STANDARD INDUSTRIAL CLASSIFICATION CODE CITY STATE ZIP COUNTY PART II Previous Business Name If held in other name during the Report Year list the name and address NAME OF PREVIOUS BUSINESS PREVIOUS FEIN ADDRESS STREET CITY STATE ZIP PART III Primary Business Activity Information IS THE HOLDER A Subsidiary Wholly Owned A Division NAME OF PARENT COMPANY Publicly Traded Private Government Entity PARENT FEIN PART IV Contact Information CONTACT PERSON TITLE TELEPHONE NUMBER EXTENSION FAX NUMBER PART V Affidavit State of County of I do hereby certify the following as of the date my signature is notarized below 1 I am duly authorized to execute this report and make the following representations on behalf of the holder listed above. 2 Said holder has performed due diligence as required by Section 35-12-31 e Code of Alabama 1975. 3 To the best of my knowledge this report is an accurate and complete account of all property in the Holder s custody which is presumed abandoned under the Alabama Unclaimed Property Act..

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