 Enlarge image |
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 2021)
12
|
 Enlarge image |
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.
13
|
 Enlarge image |
UP-1K (Rev. 0 /5 2022)
GEORGIA DEPARTMENT OF REVENUE
UNCLAIMED PROPERTY PROGRAM
HOLDER REPORT SUMMARY
FORM UP-1K
2022
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.
|
 Enlarge image |
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!
15
|
 Enlarge image |
UP-2K (Rev. 05/2022
GEORGIA DEPARTMENT OF REVENUE
UNCLAIMED PROPERTY PROGRAM
DETAIL REPORTING FORM UP-2K - SAFEKEEPING
2022
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
|
 Enlarge image |
INSTRUCTIONS FOR FORM UP-3K
SAFEKEEPING INVENTORY
FORM
2021
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.
17
|
 Enlarge image |
UP-3K(Rev. 0 /5 2022)
GEORGIA DEPARTMENT OF REVENUE
UNCLAIMED PROPERTY PROGRAM
INDIVIDUAL SAFE DEPOSIT BOX
CERTIFICATE OF INVENTORY
FORM UP-3K
2022
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: _________________________
|
 Enlarge image |
SUBMISSION INSTRUCTIONS
PLEASE USE THE FOLLOWING SCHEDULE IN REPORTING AND DELIVERY OF
SAFE DEPOSIT BOXES:
A. JANUARY 2023 - BANK OF AMERICA
B. FEBRUARY 2023 - TRUIST
C. MARCH 2023 - WELLS FARGO
D. NOVEMBER 1, 2022 - 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
19
|