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Universal Holder Face Sheet

State of California Controller s Office Universal Holder FACE SHEE T (mu st be completed an d attached wit h all reports) UFS-1(Rev. 01/15) Mail to: Office of State Controller Betty T. Yee, unclaimed property Division, Box 942850, Sacramento, CA 94250 Notice report Remit report Due Before November 1 or Due Between June 1 and June 15 or Life Insurance Due Before May 1 Life Insurance Due Between December 1 and December 15 Supplemental Notice report (Properties not included on the Notice report cannot be listed on the Remit report and must be reported on a Supplemental Notice report ) report ID# (Remit report Only) Required Section A Holder Information FEIN Branch Number report As of Date Check Number / EFT Debit Ref Number (Remit report Only)

Mail to: Office of State Controller Betty T. Yee, Unclaimed Property Division, P.O. Box 942850, Sacramento, CA 94250 Notice Report Remit Report Due Before November 1 or Due Between June 1 and June 15 or Life Insurance Due Before May 1 Life Insurance Due Between December 1 and December 15

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