Transcription of AP- 1 REPORT OF ABANDONED AND UNCLAIMED …
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AP- 1 REPORT OF ABANDONED AND UNCLAIMED …
HOLDER INFORMATION:Holder s Name _____Federal EIN Number _____Contact Name _____Phone _____ Email _____Address 1 _____City _____State _____ Zip Code _____County _____State of Incorporation _____ Assets $ _____Annual Sales $ _____Number of Employees _____ REPORT Year _____Is this the first time your organization has filed an ABANDONED and UNCLAIMED property REPORT to the Commonwealth of Pennsylvania? YES ____ NO ____Have you ever reported under another company name? YES ____ NO ____ If so, under what company name? _____ Federal EIN # _____Please fill in the blanks below for a positive REPORT . REPORT should be signed by Company President, Chief Executive Officer or Chief Financial Officer. (For negative reports, please use the new AP-1 Neg form .)I have prepared and examined this AP-1 REPORT consisting of _____ pages totaling $_____ as to property presumed ABANDONED under the Pennsylvania Disposition of ABANDONED and UNCLAIMED property Act (DAUPA) for the year ended as stated.
Chief Financial Officer. (For negative reports, please use the ‘AP-1 Neg’ form.) I have prepared and examined this AP-1 report consisting of _____ pages totaling $_____ as to property presumed abandoned under the Pennsylvania Disposition of Abandoned and Unclaimed Property Act for the year ended as stated.
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