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DFS-UP-121                                                   STATE OF FLORIDA 
                                             ANNUAL REPORT OF PROPERTY PRESUMED ABANDONED                                 FOR CASH ITEMS 
                                              NOT REPORTABLE IN AGGREGATE 
MAIL TO:       
                                PURSUANT TO THE FLORIDA DISPOSITION OF UNCLAIMED PROPERTY  
State of Florida                                    CHAPTER 717, FLORIDA STATUTES  
Department of Financial Services 
Bureau of Unclaimed Property  
P.O. Box 6350                    Covering UNCLAIMED ITEMS as of ___December 31, _______________ 
Tallahassee, FL 32314-6350   
(850)413-5522                    UPID Number (From DFS-UP-111 Cover Sheet)____________________    
                                              
                                 Federal Tax Identification Number (FEIN) __________________________ 
                                                                                     
 CASH                        NAME and LAST KNOWN ADDRESS                            SSN/FEIN OF PROPERTY   DATE     IDENTIFYING 
 AMOUNT                 (Street, City & State) date of birth of owner(s) including   OWNER       TYPE       OF LAST   NUMBER 
 REPORTED                         all joint/alternate owners,                                     CODE     TRANS- 
                                 beneficiaries, and relationship                                           ACTION 
                                  LAST NAME FIRST 
                    
$_____________ PAGE TOTAL 
Effective Date 2-12-97 
Rule 69I-20.034, F.A.C.           



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                                       DFS-UP-121 FOR CASH ITEMS 
This form is used to list the ‘Cash” related property amounts due for owners.  The remittance (payment) for these items is 
due at the same time you submit your unclaimed property report.       
REMINDER:  The Department forms cannot be used if your unclaimed property report includes 25 or more 
owners.   

DFS-UP-121 F  ORM  ETAILD       
  A. Column “      CASH AMOUNT REPORTED           ” - Enter the sum of the cash amount(s) due the owner.   
   
  B. Column “      NAME and LAST KNOWN ADDRESS              ” - Enter the last name, first name and full middle name, if 
     available.  Corporate or other titles must be entered exactly as adopted, except the word “the” must be omitted 
     when it is the first word in the name.  If the owner name is not known, insert “Unknown” as the owner name.  List 
     the last known address, including zip code of the owner as it last appeared in the holder’s records.  Include the 
     address, even when incomplete or erroneous.  If no address is available, insert “Address Unknown” beneath the 
     name.  If the property has more than one owner, the names and addresses of the alternate owners must be listed 
     beneath the original owner’s name.  If there is no alternate owner for this account, then the wording “No Alternate 
     Owner” must be entered after each account    .
 
            1. The relationship between the owners must also be shown (A list of valid relationship codes can be found 
               in the RELATIONSHIP CODE TABLE).  Enter the date of birth, if available.  Reports not adhering to 
               these requirements will be returned to the holder to supply the omitted information and are subject to 
               potential fines and interest penalties.   
 
  C. Column “      SSN/FEIN OF OWNER   ” - Enter the social security number of the individual or FEIN for the business 
     of the reported owner of the property.  Social security numbers must be reported, specifically for payroll items, 
     bank accounts, and life insurance and securities holdings.  If the alternate owner’s SSN is available, it must also 
     be reported.  If no social security number is available, insert “Unknown” in this column.  Common abbreviations 
     are SSN, FEID, EIN, and TIN.  The SSN/FEIN of owner is required information that must be included on the 
     report. 
   
  D. Column “  PROPERTY TYPE CODE          ” - Enter the property type code of each item.  The property type codes are 
     listed in the FLORIDA PROPERTY CODE AND DORMANCY TABLE.  Select the 4-character code that 
     best describes the property being reported.  The property type code is required information that must be included 
     on the report. 
 
  E. Column “      DATE OF LAST TRANSACTION           ” - Enter the date the property became payable, redeemable or 
     returnable.  This is the date of the vendor check, the date a dividend became payable, the date a note became 
     payable, the date a check or draft was issued, etc. or the last date there was positive contact from the owner 
     regarding the property.  The date of last transaction is required information that must be included on the report.   
 
 The Date of Last Transaction is not the date of the holder’s due diligence letter.  
 Make sure that all reported accounts have reached the end of their statutory 
 dormancy period. 
  
  F. Column “IDENTIFYING NUMBER” - Enter the identifying number of each item such as check number, 
     account number, employee number, etc.  This number is not the holder number or federal employer identification 
     number.  The identifying number is required information that must be included on the report. 
 
 ALL of the columns on the form must be completed.  Any incomplete forms 
 will be recorded as non-compliant and will be returned to the holder to correct.  
 Information not known must be marked as “Unknown”.  



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NOTE for all Florida County Clerk of Courts – for the reporting of unclaimed property covered under other Florida 
Statutes (For Example: ss. 43.19, 550.1645, 733.816, 732.107, 732.1101, 705.103, 402.17 or 744.534, Florida 
Statutes) contact the Bureau at 850-413-5522 to obtain the information on how to report the unclaimed 
property. 
 






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