| Page __________ | ||||||||||
| Of ____________ | ||||||||||
| OKLAHOMA STATE TREASURER | HOLDER | |||||||||
| State of Oklahoma | ||||||||||
| Unclaimed Property Division | ||||||||||
| 2300 N Lincoln Blvd., Rm 217 | (City) | (State) (Zip) | ||||||||
| Oklahoma City, Oklahoma 73105-4895 | 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. | ||||||||||