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Unclaimed Funds Required Claim Documents

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The Following Is A List Of Documents Required To Be Filed With Your Claim:

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1. Completed Claim Affirmation Form signed by the property owner.

A. You must notarize the Claim Affirmation Form if:

1) The total value of the claim is $1,000 or greater;

2) The claim is for safe deposit box contents; or

3) The claim is for securities, such as:

a) Stocks;

b) Mutual funds;

c) Bonds; or

d) Debentures.

B. If the property lists multiple owners, please provide the following:

1) Each owner must sign a Claim Affirmation Form. Multiple owners may submit their Claim Affirmation Forms together if they are sharing the same documentation to support the claims.

a) If the owners submit separate Claim Affirmation Forms, each claim should

contain all requested documentation.

2) If the property is a safe deposit box, and all owners are living, a Safe Deposit Box Property Release Form may be requested to be signed by all owners authorizing the release of the contents to one owner. You can find the release form on our Web site at: http://www.sco.ca.gov/upd_form_claim.html.

3) If you believe you are entitled to a deceased co-owner’s portion of the property, provide a copy of the deceased owner’s certified final death certificate, and all documents identified in items 13, 14, or 15 of the Deceased Owner Heir Claim filing instructions. You can find the instructions on our Web site at: http://www.sco.ca.gov/upd_claim_filinginstr_heirs.html.

Note: Each verified owner will receive his or her portion of the property as determined from information provided to the State Controller’s Office (SCO) by the company that reported the property or by proof of entitlement provided by the claimant.

2. Copy of your current Driver License or State-Issued Photo Identification Card.

A. If you do not have a valid Driver License or State-Issued Photo Identification Card, you may provide:

1)Military Identification Card; or

2)Color copy of the first and last page of your valid passport.

B. If your name is different from the reported owner’s name, provide documentation that verifies your name change.

3. Proof of your Social Security Number (SSN).

4. If you are a foreign citizen and do not have a SSN or ITIN, provide all of the following:

A. Completed and signed U.S. Government Internal Revenue Service (IRS) Form W-8 BEN,

Certificate of Foreign Status, which you can find at http://www.irs.gov/pub/irs- pdf/fw8ben.pdf; and

B. Color copy of the first and last page of your valid passport.

1) If you do not have a passport, provide a minimum of two forms of

government- issued identification3. Suggested documents:

a) Copy of your certified birth certificate and, if it is in a language other than English, a certified English translation

b) Copy of your current voter registration card

c) Copy of your current consular identification card

d) Copy of your current resident visa

5. If you are claiming property on behalf of a minor, provide:

A. Proof of minor’s SSN. Suggested documents:

1) Copy of minor’s Social Security card

2) Minor’s original pay stub (if entire SSN shown)

3) Copy of minor’s IRS Form W-2, statement of wages earned (if entire SSN shown)

B. Proof of minor’s age. Suggested documents:

1) Copy of minor’s birth certificate

2) Copy of minor’s Driver License or State-Issued Photo Identification card

3) Color copy of the first and last page of the minor’s passport

C. Proof of custody/guardianship. Suggested documents:

1) In the case of married parents, copy of minor’s birth certificate

2) In the case of divorce, court documents

3) Conservator/Guardianship letters

4) Adoption documents

D. Proof that the property belongs to the minor. Suggested documents:

1) Original bank statement (if the property is from a bank or financial institution)

2) Stock certificate or original account statement (if the property is from an investment company)

6. Proof of your current mailing address.

Suggested documents:

A. Original pay stub

B. Copy of received tax statement, such as:

· IRS Form W-2, statement of wages earned

· IRS Form 1098, statement of interest paid

· IRS Form 1099-INT or 1099-DIV, statement of interest or dividends earned

C. Copy of mortgage statement or real estate property tax bill

D. Original telephone, cable, or utility bill

E. Original bank or credit card statement

7. Proof that you received mail at the reported address.

You can find the reported address on the claim details page printed with your claim form. If you cannot provide this documentation with your claim, we may contact you for additional information.

Suggested documents:

A. Original bill or account statement from the reporting company

B. Original pay stub

C. Copy of received tax statement, such as:

· IRS Form W-2, statement of wages earned

· IRS Form 1098, statement of interest paid

· IRS Form 1099-INT or 1099-DIV, statement of interest or dividends earned

D. Copy of mortgage statement or real estate property tax bill

E. Original telephone, cable, or utility bill

F. Original bank or credit card statement

8. If there is no reported address on the claim details page printed with your claim form, provide proof that

the property belongs to you.

If you cannot provide this documentation with your claim, we may contact you

for additional information.

Suggested documents:

A. Original bank statement (if the property is from a bank or financial institution)

B. Stock certificate or original account statement (if the property is from an investment company)

C. Original invoice or receipt from the reporting company

D. List of the safe deposit box contents (if the property is a safe deposit box)

9. If you are claiming Mineral Rights or Royalties, provide proof that the property belongs to you.

Suggested documents:

A. Copy of royalty payment (check stub or copy of check)

B. Division Order

C. Copy of IRS Form 1099-MISC, statement of miscellaneous income earned

D. Statement of Royalties (from the company)

10. If the property you are claiming is a negotiable instrument,

Such as a check, cashier’s check, traveler’s check, money order, bond, or bond coupon, and you have the original instrument, provide a copy of the negotiable instrument with your claim. If we determine that we have your funds, we will contact you for additional information.

1 The claim form must be signed by one of the following, as appropriate: the property owner, the property owner’s guardian, custodian, conservator, or, if the property is in the name of a trust, the trustee(s).

2 We may accept a Durable Power of Attorney (DPOA) in cases where a medical condition prevents the property owner from signing the claim form. In such a case, our Legal Office will determine whether or not to accept a DPOA. To submit a claim signed by a DPOA, include all pages of the DPOA agreement and a medical verification signed by a licensed physician that states the property owner who is the subject of the DPOA is unable to sign the claim form because they are disabled, incapacitated or incompetent and are unable to handle their affairs.

Any claim signed by a DPOA that does not contain medical verification by a licensed physician will be denied without consideration.

3 We may contact you for authentication of foreign documents.

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Contact

(877) 450-6545

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117 Bernal Road Suite 70-281

San Jose Ca 95119