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Verification and Checklist for Unclaimed Property

AC2709 (Rev. 2/20) New York State Comptroller OFFICE OF Unclaimed FUNDS. TH. 110 State Street, 8 Floor Albany, NY 12236-0001. Verification AND Checklist FOR Unclaimed Property . reporting Organization: Verification for Period Ended , 20. State of Incorporation (name of business). Date of Incorporation Are You Authorized To Do Business in NYS? (area or department, , Corp Trust Division). FEDERAL EMPL ID NO: (street address). Contact Person Contact Title (street address). Contact Phone ( ). Contact Fax ( ). (city, state, zip code). Address (service bureau, if used). (service bureau contact name). Email Address (service bureau contact phone). I certify that I am a duly authorized officer of the above named organization. To the best of my knowledge and belief this report is a true and complete statement of all abandoned Property held by, or owing by, this organization as of the report period end date.

OFFICE OF UNCLAIMED FUNDS. 110 State Street, 8. TH . Floor Albany, NY 12236-0001 . VERIFICATION AND CHECKLIST FOR UNCLAIMEDPROPERTY. Reporting Organization: Verification for Period Ended , 20 (name of business) State of Incorporation Date of Incorporation (area or department, e.g., Corp Trust Division)

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