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                  Page __________  
                  Of ____________  
  OKLAHOMA STATE TREASURER           HOLDER      
    State of Oklahoma                
    Unclaimed Property Division                
    9520 N May, Lower Level         (City) (State) (Zip)    
  Oklahoma City, Oklahoma 73120           FEDERAL EMPLOYER ID NO.      
              REPORT YEAR      
  REPORT OF UNCLAIMED PROPERTY                  
Note: According to OS Section 661B.1. Report of Abandoned Property - Items of value under Fifty Dollars ($50.00) each must be reported in the aggregate, except property which is one of a recurring number of continuous                    
payments (re: 8 below and https://www.ok.gov/treasurer/documents/Form_497_UP_2_Instructions_Revised.pdf)                    
PROPERTY NAUPA AMOUNT ADDITIONS AMOUNT PAID TO AMOUNT DATE OF LAST OWNER'S LAST NAME, FIRST NAME, MIDDLE NAME OWNER SOCIAL  
DESCRIPTION PROPERTY REPORTED TO AMOUNT OWNER OR DELETED REMITTED TRANSACTION OR LAST KNOWN STREET ADDRESS SECURITY NUMBER  
ACCOUNT # CODE AS DUE REPORTED TYPE AMOUNT   DATE PROPERTY CITY, STATE, ZIP OR FEI NUMBER  
OR CHECK #   OWNER     (*See note below)   BECAME PAYABLE      
(1) (2) (3) (4) (5a) (5b) (6) (7) (8) (9)  
    0.00       0.00   AGGREGATE - Items of value under fifty ($50.00) each must be reported in aggregate, except property which is one of a recurring number of continuous payments, including, but not limited to, royalties, annuities, dividends. No detail should be submitted regarding items to be included in aggregate.    
    0.00       0.00        
    0.00       0.00        
    0.00       0.00        
    0.00       0.00        
    0.00       0.00        
    0.00       0.00        
    0.00 0.00   0.00 0.00        
497-UP-2             (IF THIS IS LAST PAGE OF REPORT, ENTER GRAND TOTAL)      
Revision 06/05/2018                    
                     
*Must be entered as a negative number in column 5b.              


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