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Safe Deposit Boxes

Report Forms and Instructions

These forms are intended for reporting safe deposit box contents.

Form UP-1K .................................. Page 13-14

 UP-2K .................................. Page 15-16

 UP-3K .................................. Page 17-18

                                                        (Rev. 0 /5 2023)

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                   INSTRUCTIONS FOR FORM UP-1K

                                      SAFEKEEPING

                   The form UP-1K must accompany all holder reports.

HOLDER INFORMATION:

Please type or print your report.

ITEM 1-  Enter your federal employer identification number.

ITEM 2-  Enter your institution name and mailing address.

ITEM 3-  If this report is being prepared by an agent on behalf of the institution, enter the agent’s name

        and address.

ITEM 4-  Enter the name of the person completing the form.

ITEM 5-  Enter the telephone number for the person completing the form.

ITEM 6-  Enter the e-mail address for the person completing the form.

ITEM 7-  Enter the date your institution was incorporated or registered.

ITEM 8-  Enter the state where your institution is registered or incorporated.

REPORT INFORMATION:
ITEM 9 - Enter total number of safe deposit boxes.

VERIFICATION:
This report must be certified by a CFO, partner or company officer.

GO TO OWNER REPORT FORM (UP-2K) TO PROVIDE A DETAILED LISTING OF THE UNCLAIMED
ACCOUNTS REFLECTED IN ITEM 9.

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UP-1K (Rev. 0 /5 2023)
GEORGIA DEPARTMENT OF REVENUE 
UNCLAIMED PROPERTY PROGRAM

                      HOLDER REPORT SUMMARY 

                                                       FORM UP-1K

                                                                   2023

                                                       SAFEKEEPING

                         This form must accompany all holder reports.

               DID YOU ATTACH A CD?  Y [    ]    N [    ]    ELECTRONIC FILERS:  Submit a UP-1K for each business included on the CD.

HOLDER INFORMATION
1.  FEDERAL EMPLOYER ID#                           2.  INSTITUTION

ADDRESS

CITY, STATE, ZIP CODE

3.  IS THIS REPORT BEING PREPARED BY AN AGENT ON BEHALF OF THE INSTITUTION?    Y  [    ]    N  [    ]  IF YES, FURNISH AGENT NAME
AND ADDRESS:

4.  NAME OF CONTACT PERSON                             5.  TELEPHONE      6.  E-MAIL ADDRESS
                                                       (          )

7.  DATE OF INCORPORATION                                          8.  STATE OF INCORPORATION

REPORT INFORMATION

9. Number of safe deposit boxes/safekeeping items _______________________

VERIFICATION STATEMENT

I ________________________________ ,certify that I have caused to be prepared and have examined this                   
report  totaling _____________ safe deposit boxes as to property presumed abandoned under the Disposition 
of Unclaimed Property Act for the year ended ____________, that I am duly authorized to execute this verification 
by  the institution and that  I believe said report to be true, correct and complete as of said date to the best of my 
knowledge.

                      Signature of Responsible Officer                    Printed or Typed Name of Responsible Officer

                      Title of Responsible Officer                                                    Date

                                                       FOR OFFICE USE ONLY
                         REPORT ID                                                           HOLDER NO.



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INSTRUCTIONS FOR COMPLETING FORM UP-2K

               A separate UP-1K for safe deposit boxes must be submitted.

Please do not submit Safe Deposit Box Reports through the online holder portal.  If you are reporting 25 or more 
properties, you must submit your report on a properly formatted read-only CD.  We also require that you submit a 
paper copy of the report.  

If you are reporting fewer than 25 properties, please use this form referencing the following instructions:
       Please type or print your report.

       List owners alphabetically by name.

       Enter the date of this report.  We will use this date as reference should we need to contact you    with
       questions regarding the report.

       Enter your federal employee identification number (FEIN).

Item 1 - Enter the owner’s name and address as shown on your business records.

Item 2 - Date of birth.

Item 3 - If multiple owners are listed, indicate the appropriate relationship code from the list on Page 4
(Introduction).

Item 4 - Enter the owner(s) social security number (SSN) or federal employee identification number (FEIN). 

Item 5 - Enter the safe deposit box number.

Item 6 - Enter the date the safe deposit box was drilled.

Item 7 - Enter the total number of safe deposit boxes reported on this page.

Item 8 - If this is the last page of your report, enter the grand total of all safe deposit boxes reported on all pages.

         NEGATIVE REPORTS ARE REQUIRED ON SAFE DEPOSIT BOXES!

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UP-2K (Rev. 05/2023
GEORGIA DEPARTMENT OF REVENUE 
UNCLAIMED PROPERTY PROGRAM 

                   DETAIL REPORTING FORM UP-2K - SAFEKEEPING 

                                                             2023 
                              When reporting 25 or more properties, a NAUPA formatted CD is required. 

                                                                                        Report  Date 

Federal Employee ID No.           Business Name 

Ga. Holder No.                                                                                                Page of 

                                                             RELATIONSHIP 
                                                       DATE  BETWEEN 
                                                       OF    OWNERS          S.S. # /   SAFE DEPOSIT BOX OR 
                   OWNER’S NAME AND LAST KNOWN ADDRESS BIRTH (IF APPLICABLE) TAX ID NO. INDENTIFYING NUMBER        DATE DRILLED 
                              (1)                      (2)   (3)             (4)        (5)                        (6) 

                                                                 (7) TOTAL SAFEKEEPING ITEMS REPORTED FOR THIS
                                                                     PAGE 

                                                                     (8) GRAND TOTAL SAFEKEEPING ITEMS FOR REPORT



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               INSTRUCTIONS FOR FORM UP-3K 

                    SAFEKEEPING INVENTORY 

                                FORM 

                                      2023
ITEM 1- ENTER BANK NAME

ITEM 2-  ENTER FEDERAL IDENTIFICATION NUMBER

ITEM 3-  ENTER HOLDER ID #

ITEM 4-  REPORT DATE

ITEM 5-  ENTER BOX OWNER 'SOR OWNERS 'NAME

ITEM 6-  ENTER RELATIONSHIP CODE (SEE PAGE 4 OF INTRODUCTION) 

ITEM 7-  SAFE DEPOSIT BOX NUMBER

ITEM 8-  DRILL DATE

ITEM 9-  NUMBER OF ITEMS IN SAFE DEPOSIT BOX (EXAMPLE: 5 $2 BILLS) 

ITEM 10- SAFEKEEPING CODE

          SAFEKEEPING CODE       SALEABLE Y/N DESCRIPTION
          1                           Y       COINS
          2                           Y       JEWELRY
          3                           N       PAPER DOCUMENTS
          4                           N       SAVINGS BONDS
          CURR                        Y       CURRENCY
          MISC                        Y       OTHER TANGIBLE PROPERTY
          STMP                        Y       STAMPS
          WEAP                        Y       VARIOUS WEAPONS
          WILL                        N       WILL
          BOND                        N       BOND COUPON/DOC.

ITEM 11- DESCRIPTION

PLEASE NOTE:   WHEN OPENING A SAFE DEPOSIT BOX , AFTER DRILLING…..IFYOU DISCOVER
A WEAPON…STOP AND CALL SECURITY IMMEDIATELY….HAVE SECURITY CLEAR THE
WEAPON….RENDERING THE WEAPON SAFE TO HANDLE….PROCEED WITH INVENTORY
RECORDING THE MAKE, MODEL AND CALIBER.

INVENTORY OF BOX SHOULD BE NOTARIZED WITH THE SIGNATURE OF BANK OFFICIAL AND 
BANK EMPLOYEE.

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UP-3K(Rev. 0 /5 2023)
GEORGIA DEPARTMENT OF REVENUE 
UNCLAIMED PROPERTY PROGRAM

                          INDIVIDUAL SAFE DEPOSIT BOX

                           CERTIFICATE OF INVENTORY

                                   FORM UP-3K

                                                            2023

                                                                                HOLDER ID
                          FINANCIAL CENTER NAME AND ADDRESS            FEIN     NO.                    REPORT DATE
                              (1)                                      (2)      (3)                                                       (4)

                                                                   RELATIONSHIP SAFE DEPOSIT BOX
                          RENTER’S NAME AND ADDRESS                    CODE     NUMBER                                           DRILL DATE
                              (5)                                      (6)      (7)                                                       (8)

On the above drill date, after notice, and in accordance with state law and the rules and regulations of  ___________________________________________________________________ 
                                                                                (Financial Institution)
and pursuant to the agreement entered into with the Renter, this financial institution in the presence of the undersigned officer and the 
undersigned Notary Public caused said Safe Deposit Box to be drilled and the contents thereof removed and inventoried as follows:
                     SAFE-
NO. OF        KEEPING
ITEMS                CODE                                   DESCRIPTION
(9)                  (10)                                   (11)

Annual Rent ______________         Drilling Fee _______________                  Total _______________

I certify that the items for box number __________ as listed above represent the entire contents of this box on the cited drilling
date.  The contents listed above have been securely wrapped, and the package plainly marked per Submission Instructions for
Safekeeping Items.

Signed  _______________________________________

Title  _________________________________________

Signed _______________________________________     (Notary Public)              - Notary Seal -

My  Commission  Expires:  _________________________



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                      SUBMISSION INSTRUCTIONS

PLEASE USE THE FOLLOWING SCHEDULE IN REPORTING AND DELIVERY OF
SAFE DEPOSIT BOXES:

  A. JANUARY 2024 -  BANK OF AMERICA
  B. FEBRUARY 2024 -  TRUIST
  C. MARCH 2024 -  WELLS FARGO
  D. NOVEMBER 1, 2023  -  ALL OTHER BANKS

   Record contents of each safe deposit box remitted to Unclaimed Property on the UP-3K Individual
     Safe Deposit Box C  ertificate of Inventory form.

   Pack safe deposit box contents in a suitable container (plastic or brown paper envelope of
     appropriate size, or a cardboard bank box).  Place a copy of the UP-3K Individual Safe Deposit Box
     Certificate of Inventory form in the container and tape a copy to the outside.

   Secure the container with bank security tape.

   If more than one container is sent, place all containers in a shipping box.

   Put the UP-2K Safekeeping Detail Report Form in an envelope and place in the shipping box.  If
     more than   one shipping box is sent, complete a separate UP-2K for each shipping box.
     Note:  The form UP-2K Safekeeping Report Form must accompany each shipping box forwarded
     to state custody.

Please send reports to:                   Georgia Department of Revenue 
                                          Unclaimed Property Program 
                                      4125 Welcome All Rd Suite 701 
                                             Atlanta, GA  30349

For additional questions contact:         Telephone: (855) 329-9863 Fax 
                                           Line: (404) 724-7013 
                                      Email: ucp.reporting@dor.ga.gov

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