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RPD-41200
03/23/2022

                                   NEW MEXICO
           Taxation and Revenue Department

           UNCLAIMED PROPERTY REPORT 

           HOLDER'S FILING KIT

Unclaimed Property Office   I   P.O. Box 25123   I   Santa Fe, New Mexico 87504-5123   I   505-827-0668   I   
                                   unclaimed.property@state.nm.us

                                   CONTENTS

           GENERAL INFORMATION .............................................1
           HOW TO USE THIS MANUAL ......................................................... 1
           YOUR RESPONSIBILITIES AS A HOLDER..................................... 1
           FILING FOR REIMBURSEMENT AND  ........................................... 2
           REFUNDS ........................................................................................ 2
           ASSISTING CLAIMANTS ................................................................. 2
           PROPERTY SPECIFIC REPORTING .............................2
           FINANCIAL INSTITUTIONS ............................................................. 2
           REPORTING SECURITIES OR SECURITIES RELATED CASH .... 4
           REPORTING AND DELIVERY OF SECURITIES PROPERTY ........ 5
           PROPERTY REPORTED BY INSURANCE COMPANIES ............... 5
           REPORTING MINERAL PROCEEDS .............................................. 6
           FREQUENTLY ASKED QUESTIONS .............................7

                                   FORMS PROVIDED IN PACKET

RPD-41201, NM Report of Unclaimed Property
RPD-41202, List of Owners of Unclaimed Property
RPD-41203, List of Owners of Unclaimed Stocks and Other Securities
RPD-41204, List of Unclaimed Contents of Safe Deposit Boxes or Other Safekeeping Repositories
RPD-41205, Holder's Negative Report
RPD-41206, Holder's Request for Reimbursement

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                         GENERAL INFORMATION
HOW TO USE THIS MANUAL                                               unit responsible for filing reports. All correspondence should 
                                                                     include your Federal Employer Identification Number (Federal 
This manual has been prepared to assist you in filing your           ID number).
unclaimed property reports with the New Mexico Taxation and 
Revenue  Department's (Department) Unclaimed  Property               The UPO is always available to assist you with special re-
Office  (UPO).  It  does  not  address  legal  issues  relating  to  porting problems. For questions, please call 505-827-0668, 
unclaimed property, nor does it describe all types of property       email unclaimed.property@state.nm.us or write Taxation and 
which must be reported. It will, however, provide instructions       Revenue Department, Attn: Unclaimed Property Office P. O. 
for reporting the more common types of abandoned property.           Box 25123, Santa Fe, NM 87504-5123 for assistance.

General Information gives an overview of unclaimed                   Retention of Records
property  reporting  and  provides  basic  information 
such as when to report.                                              All holders are required to retain records of unclaimed property 
                                                                     for ten (10) years. You may be contacted periodically by the 
The Property Specific Reporting section discusses                    UPO to verify previously reported information.
some of the more common types of unclaimed 
property.                                                            Notice to Owners (Due Diligence)

Frequently Asked Questions from unclaimed property                   The New Mexico Unclaimed  Property Act  requires you to 
holders, such as the bank or business you represent,                 send written notice to the apparent owner at the owner’s last 
are answered.                                                        known address not more than one hundred twenty (120) days 
                                                                     before filing the report.
Reports must be filed on or before November 1 of each year 
for the twelve months next preceding July 1 of that year, but        Negative Reports
a report with respect to a life insurance company must be 
filed on or before May 1 of each year for the calendar year          If the holder has no unclaimed property to report, the holder 
next preceding. Tangible property held in a safe deposit box         will need to file Form RPD-41205, Holder's Negative Report, 
or other safekeeping depository may not be delivered to the          on November 1, or May 1 for life insurance companies. When-
administrator until one hundred twenty (120) days after filing       ever possible, the negative reports should be filed online at 
the report required by Section 7-8A-7 NMSA 1978 of the Uni-          https://holdernm.unclaimed property.com/ 
form Unclaimed Property Act [7-8A-1 to 7-8A-31 NMSA 1978].
                                                                     Starting May of 2022, negative report filing is no longer required 
After property has been delivered to the UPO, the holder should      from out-of-state holders who filed negative reports for the 
refer owners to UPO to handle their claim. The UPO's goal is         past three consecutive years. However, the holder is able to 
to reunite as many people as possible with their unclaimed           file the negative reports if they would like to.
property. Once the holder has delivered remittance to our of-
fice, unclaimed property owners may file a claim at any time         If the holder never acquired unclaimed property and currently 
thereafter. There is not a time limit.                               does not have funds to report, do not file the negative report. 

An option does exists for you the holder to pay the claim-           Supplemental Reports
ants directly, and file for reimbursement from the UPO. The 
holder must file on Form RPD-41206, Holder's Request for             If you find it necessary to file a supplemental report at any 
Reimbursement and provide proof the owner has been re-               time, do not combine the report with any previously reported 
imbursed the funds.                                                  accounts. Prepare a new report and indicate in a cover letter 
                                                                     that it is a supplemental filing.

YOUR RESPONSIBILITIES AS A HOLDER                                    Electronic Filing

The New Mexico Report of Unclaimed Property requires                 Whenever possible, the UPO encourage all holders to report 
that you provide your Federal Tax ID, current address,               their unclaimed property to the UPO electronically online at 
contact person, phone number and E-mail address.                     http://holdernm.unclaimedproperty.com/. The Department will 
                                                                     ONLY accept electronic data in the NAUPA (National Unclaimed 
It  is the holders responsibility  to  keep UPO advised of a         Property Administrators) format. Note: The UPO no longer ac-
current address and any changes in the contact person or             cepts electronic media such as USB Drive or compact disks.

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Effective July 1, 2006, all reports containing more than 25  make every effort to respond to your request as quickly as 
properties are required to be submitted electronically. If you  possible. To obtain reimbursement the holder must complete 
would like more information about electronic reporting, please     and properly execute Form RPD-41206, Affidavit by Holder 
call 505 827-0668 or email unclaimed.property@state.nm.us.         for Return of Property Presumed Unclaimed.

Computer Printouts                                                 After we receive your affidavit, a check will be mailed to you 
                                                                   approximately within ninety (90) days.
Computer listings cannot be accepted in lieu of the approved 
reporting forms unless all required data fields are included on    REFUND: Refunds are made to holders who have overpaid 
the printout. Property type codes must appear on the printout.  their unclaimed property reports. The overpayments are usually 
Refer to the forms and instructions for a listing of the approved  due to accounting errors or other mistakes made during the 
codes. Electronic Filing is encouraged as much as possible.  preparation of reports. To file for a refund, write a letter to the 
See Electronic Filing.                                             UPO, explain the error or mistake, and include an amended 
                                                                   report. The refund will be processed within ninety (90) days 
Additional Forms                                                   after the holder has satisfactorily documented the overpayment.

You can locate additional forms on our website here https://
www.tax.newmexico.gov/forms-publications/ in the "Unclaimed        ASSISTING CLAIMANTS
Property" folder or you may photocopy the blank forms. The 
Department does encourage you to file your forms electroni-        Unclaimed property owners may contact the holder after the 
cally whenever possible, please see Electronic Filing.             property has been remitted to the UPO. These owners should 
                                                                   be referred to the UPO.
Aggregate Reporting
                                                                   When the reimbursement  process is not possible,  direct 
Individual owner accounts of less than $50 may be reported 
as aggregate. If the holder wishes to avoid the UPO contact-       potential claimants should initiate a claim by going to https://
ing them each time an owner files a claim for under $50, the       missingmoney.com, calling 505-827-0668 , or writing:
holder may want to list each individual owner separately.
                                                                   Taxation and Revenue Department
Failure to Report                                                  Attn: Unclaimed Property Office
                                                                   P. O. Box 25123
A holder who fails to report, pay or deliver property within the   Santa Fe, NM 87504-5123
time prescribed by the Uniform Unclaimed Property Act shall 
pay interest at the computed daily rate established by the         For more information on filing a claim please see our web-
U.S. Internal Revenue Code (IRC) on the property or value  site    https://www.tax.newmexico.gov/individuals/what-is-
thereof from the date the property should have been reported,      unclaimed-property/file-a-claim/.
paid or delivered.
                                                                   How Claims are Processed
The IRC rate changes quarterly, and is announced by the 
Internal Revenue Service in the last month of the previous         One objective of the UPO is to process and pay all unclaimed 
quarter. The annual and daily interest rate for each quarter will  property claims within ninety (90) days. Claimants are required 
be posted on our website at https://www.tax.newmexico.gov/         to provide the UPO with sufficient proof and documentation to 
individuals/file-your-taxes-overview/penalty-interest-rates/.      substantiate ownership and entitlement for payment.

FILING FOR REIMBURSEMENT AND                                       Proof provided by claimants is compared with owner infor-
                                                                   mation and property descriptions provided by, the reporting 
REFUNDS                                                            company or institution. When preparing your report, assume 
                                                                   each owner you list is a potential claimant. It is essential 
There are two types of payments the UPO will make to holders 
                                                                   that all available information which identifies owners and 
after they have remitted their unclaimed property. The most 
                                                                   properties be listed on your report to the UPO.
common type is a reimbursement; the second type is a refund.
                                                                   Social security numbers, last known addresses, and property 
REIMBURSEMENT: In this process, a holder decides to pay 
                                                                   descriptions are three items used to verify ownership during 
an owner and then files a claim with the UPO for reimburse-
                                                                   the claims process. Providing this and other descriptive in-
ment. We encourage the holder to use the reimbursement 
                                                                   formation on your report will reduce the need for the UPO to 
process for those customers and owners demanding imme-
                                                                   contact you for additional information during the claims process.
diate payment or reinstatement of their accounts. The UPO 

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            PROPERTY SPECIFIC REPORTING
FINANCIAL INSTITUTIONS                                                instructed that interest be added to the principal amounts of 
                                                                      the certificates, the interest must be reported with the principal 
Financial institutions include, but are not limited to, savings and   five years from the date of first maturity.
loan associations, building and loan associations, industrial 
banks, other banking organizations and credit unions.                 Don’t  Forget:  If  certificates  of  deposit  owners have other 
                                                                      active accounts with the financial institution, do not report or 
When unclaimed properties are held for the appropriate dor-           remit their dormant certificates.
mancy periods, include them on the next unclaimed property 
report filed with the UPO. The dormancy periods are determined        Reporting Individual Retirement Accounts
by the property types.
                                                                      Individual Retirement Accounts (IRAs) have a dormancy pe-
                                                                      riod of three years. The dormancy period begins no later than 
DORMANCY PERIODS
                                                                      the date the owner of the IRA reaches age 70-1/2 which is 
FIVE-YEAR PROPERTIES: All types of demand deposit ac-                 the mandatory distribution date under federal law. Thus, the 
counts and savings accounts have five-year dormancy periods.          dormancy period commences the day after the owner reaches 
Abandoned safe deposit box contents and matured certificates          the age of 70-1/2 years. Any individual retirement accounts 
of deposit are also reportable after five years of inactivity.        dormant for more than three years on June 30 should be 
                                                                      included on the November 1 report. If some event, such as 
Other types of unclaimed property reportable by financial in-         death of the owner occurs prior to the owner reaching age 
stitutions include, but are not limited to, all types of uncashed     70-1/2, commence the dormancy period from the date of the 
checks; trust-related properties, investments and escrow ac-          owner's death.
counts; all types of securities-related properties; other sums 
payable under pension and profit-sharing plans; safekeeping           Trust Properties
properties; and miscellaneous types of unclaimed property 
                                                                      If you have trust properties to report, remember to list ben-
such  as  unidentified  remittances.  See Retention Period & 
                                                                      eficiaries of trusts as primary owners. For instance, we will 
Property Type Codes.
                                                                      publish the names of minor children on accounts held under 
                                                                      the Uniform Gift to Minors Act (UGMA). 
ONE-YEAR PROPERTIES: Employee wages - See Retention 
Period & Property Type Codes.
                                                                      If the trust properties you hold are securities-related, you must 
                                                                      complete  Form RPD-41203,  List of Owners of Unclaimed 
Non-Return Mail
                                                                      Stock and Other Securities.
The non-return of mail does not constitute activity on an ac-
count. In other words, financial institutions cannot assume it        Any personal trust properties which are not securities-related 
knows the whereabouts of customers just because the post              may be reported on the regular reporting Form RPD-41202, 
office did not return their customers monthly statements. When        List of Owners of Unclaimed Property.
reviewing records for dormant accounts, remember to look for 
the last debit or credit generated by the owners.                     If you are holding any properties in safekeeping for trust cus-
                                                                      tomers, report them in the same manner as safe deposit box 
Reporting Certificates of Deposit                                     contents. Refer to the Reporting Safe Deposit Box Contents 
                                                                      or Safekeeping Property.
The dormancy period for matured certificates of deposit is 
five years. The dormancy period begins on the day following           Corporate Trust Properties
the first maturity of the certificates - that is, the day following 
the end of the first term. Thus, certificates of deposit must be      Corporate trust properties are to be reported on Form RPD-
reported five years from the dates the owners were first able         41203, List of Owners of Unclaimed Stock and Other Securi-
to recover the funds without penalties.                               ties. The following rules should be observed when reporting 
                                                                      corporate trust properties:
When remitting automatically renewable certificates of deposit, 
you may hold the funds on November 1, waiting to remit on                 1.  List minor children as primary owners of properties 
the date of next maturity. This option is available if the financial         on UGMA accounts. The trustees should be listed as 
institutions wish to avoid charging the owners interest and or               additional owners.
penalties for early withdrawal under the current terms.
                                                                          2.  If you are reporting bearer bonds or unclaimed inter-
Interest earned on certificates of deposit must be reported five             est on the bonds, the owners of the properties should 
years from the date it was payable. However, if the owners 
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       be listed as unknown. Complete descriptions of the  names on each inventory sheet, as well as the name of the 
       bonds must be provided in the description field.           financial institution. Place each original inventory inside the 
                                                                  corresponding owner envelope. Attach the second copy of 
3.  When  reporting  bond  interest,  list  all  outstanding      the inventory to the outside of each box to correspond 
       coupon numbers in the description field.                   with owner contents. Insure that your company name and 
                                                                  report date is on the outside of each box.
4.  If you are reporting dividends received in nominee 
       name, the stock issues must be listed in the descrip-      1.  Securities  -  Securities  include  stock  certificates, 
       tion field. The owners must be listed as unknown.                 government  bonds,  interest  coupons,  etc.  When 
                                                                         describing securities-related properties, include the 
5.  If you are remitting underlying shares, shares returned              registered owners' names, issuing companies, and 
       by  the  post  office  (RPO  shares),  or  both,  please          number of shares.
       combine all shares of the same issue and class in 
       one  certificate.  Your  report,  however,  must  reflect  2.  Firearms  and  Controlled  Substances  -  Please 
       the number of shares which are underlying and the                 advise the UPO when firearms or controlled sub-
       number which are RPO for each of the owners.                      stances are enclosed prior to delivery.

6.  Please begin the registration change process early  Mail or deliver the contents to the UPO on your designated 
       enough so that securities are delivered to the UPO  delivery date. Courier service is not required but is suggested 
       no later than November 1.                                  when your contents include valuables. If you choose to deliver  
                                                                  property by the U.S. Postal Service, the property should be 
Reporting Unclaimed Loan Collateral                               sent certified, return receipt requested.

Unclaimed loan collateral should be reported five years after     Please mail to:
the date the loan was paid in full. It should be reported us-
                                                                         Taxation and Revenue Department
ing property type codes from the back of Form RPD-41201, 
                                                                         Attn: Unclaimed Property Office
New Mexico Report of Unclaimed Property. When reporting 
                                                                         P. O. Box 25123
unclaimed loan collateral, refer to the safe deposit boxes 
                                                                         Santa Fe, New Mexico  87504-5123
instructions below.
                                                                  Please deliver to:
Reporting  Safe  Deposit  Box  Contents  or  Safekeeping 
Property  (includes unclaimed loan collateral)
                                                                         Taxation and Revenue Department
                                                                         Attn: Unclaimed Property Office
On November 1 of each year, report to the UPO safe deposit 
                                                                         Manuel Lujan Building
box contents, safekeeping properties, loan collateral, and any 
                                                                         1200 South St. Francis Drive
other tangible properties that have remained unclaimed by 
                                                                         Santa Fe, New Mexico  87504
the owners for more than five years. Use Form RPD-41204, 
List of Unclaimed Contents of Safe Deposit Boxes or Other 
                                                                  For  deliveries, please call or  email the  UPO  to  set  up an 
Safekeeping Repositories, to report these items.
                                                                  appointment for the delivery. For questions, please call 505-
                                                                  827-0668 or email unclaimed.property@state.nm.us.
The five-year dormancy period for safe deposit box(es) con-
tents begins from the date the last rental payment expired. DO 
NOT send the contents of safe deposit box(es) along with the      REPORTING SECURITIES OR 
report. You must wait 120 days after filing Form RPD-41204 
                                                                  SECURITIES RELATED CASH
with the UPO before you can deliver the items to the UPO 
(7-8A-8 NMSA 1978). This postmark date of receipt is the 
filing date of the report.                                        Securities or securities-related cash are to be reported on 
                                                                  Form RPD-41203,   List of Owners of Unclaimed Stock and 
All contents MUST be inventoried and listed on Form RPD-          Other Securities.
41204, List of Unclaimed Contents of Safe Deposit Boxes or 
Other Safekeeping Repositories. Any items that have, or may       General Rules for Reporting
have, a monetary value should be inventoried separately. If you 
have letters, slips of papers, pictures, or items of a personal   1.  Do not aggregate cash dividends or any other prop-
nature, these may be inventoried together.                               erty type which involves a periodic distribution to the 
                                                                         owner.
Two copies of the inventory must accompany the contents 
of each box. Include the box or account numbers and owner         2.  List the minor child as the primary owner of the prop-
                                                                         erty on a Uniform Gift to Minors Act (UGMA) account. 
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        The trustee should be listed as an additional owner.
                                                                 A confirmation statement showing Hare & Co as the owner 
3.  If you are reporting bearer bonds or unclaimed inter-        of the shares must accompany Form RPD-41201, Report of 
        est on the bonds, the owner of the property should       Unclaimed Property be considered complete.
        be listed as unknown. A complete description of the 
        bond, including bond number, must be provided in         Register and deliver physical certificates as follows:
        the description field.
                                                                 Certificates must be registered as shown below.  A photocopy 
4.  When reporting bearer bond interest, the description  of the certificate should be delivered with your report and the 
        field should include the outstanding coupon numbers.     original certificate sent to our custodian. Please be advised 
                                                                 that certificates registered incorrectly will be returned to you for 
5.  The stock issue must be listed in the description field  re-registration and your report will be considered incomplete.  
        if your are reporting dividends received in nominee  Register in Nominee Name: Hare & Co, FEIN: 13-6062916. 
        name. The owner must be listed as unknown.               Deliver certificates to:

6.  If you are remitting underlying shares, shares returned      BNY Mellon/Branch Deposit Department
        by the post office (RPO share), or both, please combine  570 Washington BLVD-5th Floor
        all shares of the same issue and class in one certifi-   Jersey City, NJ 07310
        cate. Your report, however, must reflect the number      Attn: BNY Mellon/Branch Deposit Department
        of shares which are underlying and the number which               For further credit to account #822472
        are RPO for each owner.
                                                                 Open End Mutual Fund
7.  Please direct the appropriate transfer agent to begin 
        the registration process. Securities must be deliv-      Mutual Fund Accounts held for the State of New Mexico must 
        ered to Mellon Security Trust Company no later           be open in advance. Avenu will provide the account numbers 
        than November 1.                                         for all mutual funds to be transferred into the state's account.  
                                                                 Please contact  Avenu at UPCH.Custody@avenuinsights.com 
                                                                 to obtain the account numbers no later than 3 business days 
REPORTING AND DELIVERY OF                                        prior to attempting delivery.
SECURITIES PROPERTY
                                                                 For ALL stock and mutual fund remittances: 
Two days prior to delivery, you MUST fax 505-827-1759 or 
email unclaimed.property@state.nm.us an    Intent to Deliver     Two days prior to actual delivery, fax an Intent to Deliver List of 
to our custodian – see instructions below.                       the securities to: Avenu Unclaimed Property Clearinghouse at 
                                                                 617-722-9660, (Attn: Loreta Pengo if a DRP, DTC, or Mutual 
All Direct Transfer Company (DTC) eligible shares MUST be        Fund) and  to the UPO at 505-827-1759.  This list should 
deposited through DTC as follows:                                include cusip numbers, number of shares, issue names and if 
                                                                 a physical certificate, a certificate number and registration for 
Nominee Name:                                                    each security to be delivered; if a DTC delivery, the delivering 
Hare & Co                                                        party’s DTC number; and if a Dividend Reinvestment or Mutual 
FEIN: 13-6062916                                                 Fund account, the account number and TIN for the issuer.
DTC Participant #901
Agent Bank # 26500                                               Avenu will provide account numbers for all mutual funds that will 
Account # 822472                                                 be transferred to the state's account. Please contact Marsela 
                                                                 Strakosha at 617-371-9914 to obtain account numbers 48 
Register Dividend Reinvestment Plan (DRP) Shares, Book           hours prior to attempting delivery.
Entry Shares or Direct Registration Shares as follows:
                                                                 If the fund chooses to establish new account numbers and 
Nominee Name:                                                    register mutual funds as indicated below, please ensure to 
Hare & Co                                                        provide a detailed list 48 hours in advance to UPCH.Custody@
FEIN: 13-6062916                                                 avenuinsights.com.  This list should  contain cusip number, 
c/o  Avenu Insight                                               name of the fund, share amount and the account number 
100 Hancock Street, 10th floor                                   at the fund. NOTE:  All new accounts should be set up with 
Quincy, MA 02171                                                 Phone Privileges.

*Please set up DRP account to allow dividends to be paid 
in cash.

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PROPERTY REPORTED BY INSURANCE                                          REPORTING MINERAL PROCEEDS
COMPANIES
                                                                        Determining What Property to Report
Reporting Deadlines (See Retention Period & Property 
                                                                        The dormancy period for unclaimed mineral proceeds is five 
Type Codes)
                                                                        years. Review your records as of June 30th of the current year 
"Insurance Company" means an association, corporation, or               and report all property which has not had owner-generated 
fraternal or mutual benefit organization, whether or not for            activity. Once an owner has been listed on a report, do not 
profit, engaged in the business of providing life endowments,           include continuing payments due on the same property on 
annuities, or insurance, including accident, burial, casualty,          reports for subsequent years.
credit  life,  contract  performance,  dental,  disability,  fidelity, 
fire, health, hospitalization, illness, life, malpractice, marine,      Aggregate Reporting of Mineral Proceeds
mortgage, surety, wage protection, and workers' compensa-
tion insurance.                                                         Please do not aggregate amounts less than $50 on your report. 
                                                                        An owner having interests in more than one well or lease of 
Insurance companies reporting non-life properties should fol-           less than $50 should be listed only once on your report with 
low the general guidelines for reporting. However, additional           the net amount due for all properties combined in one total. If 
information that will assist in identifying the owners should           the net amount due an owner on all leases is a negative, 
be listed in Funds Description. Holders must specify in the             do not include it on your report.
description field the types of insurance they are reporting. Use 
the abbreviation AH for accident and health insurance and               Amounts to Report
PC for property and casualty insurance.
                                                                        The amount to be reported is the total due to the owners as 
All descriptive information listed in the description field should      of the close of business on June 30.
be preceded by abbreviations which indicate what you are 
describing. Please refer to the list below.                             Other Types of Property Which Must be Reported by Oil 
                                                                        & Gas Companies

                 ABBREVIATIONS                                          Oil and gas companies are required to report other types of 
                                                                        property besides mineral proceeds. The Retention Period & 
          AH        Accident & Health                                   Property Type Codes listed on page 11 should be reviewed 
          BENF      Beneficiary                                         closely to determine if other types of unclaimed property are 
                                                                        held, such as securities and securities related cash, expense 
          CK        Check                                               checks, vendors checks and employee wages.
          DRFT      Draft
          L         Life Insurance
          DOB       Date of Birth
          ENDW      Endowment
          GRP       Group Policy
          INS       Insured
          MAT       Matured Policy
          PC        Property & Casualty
          PDUP      Paid-up Policy
          POL       Policy Number

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            FREQUENTLY ASKED QUESTIONS
To whom do I make my remittance check payable?                      instructions for distribution at death, maturity, majority, 
Your remittance check should be made payable to the      New        or some other specific distribution date is considered 
Mexico  Taxation  and  Revenue  Department,  Unclaimed              abandoned five years after the date has passed if 
Property. Please prepare one check for each report you file.        there has not been any activity by the owner or his/
                                                                    her designated representative.
Do I need to notarize my report?
No.                                                            Are we supposed to report garnishments? How should 
                                                               they be listed on the report?
What  do  I  enter in  the  "Verification  for  Period  Ended" Garnishments are reported if the money was held or set aside 
blank on Form RPD-41201?                                       by a "Writ of Garnishment," but no further action occurred. 
Enter June 30 of the current fiscal year for corporations and  Never report a garnishment account if legal action is pending. 
December 31 for life insurance companies.                      If no further action occurred, such as an order from the court 
                                                               for the defendant to pay or a notice that the action is dissolved 
I received unclaimed property reporting forms from other       or terminated, then the funds should have been redeposited 
states. How should I report?                                   into the owner's account. This is the point at which an owner 
Unclaimed property should be reported to the state of last known  often becomes lost.  The account (check) is reportable  as 
address of the missing owner. If the address is unknown, the   unclaimed property one year after the last owner contact or 
property should be reported to the state where your company    activity. A garnished account or an account held as a result 
is incorporated. If property with a last known address other   of a "Writ of Garnishment" should be reported with as much 
than New Mexico is reported to the New Mexico Unclaimed  information as you can provide. Since at this point you are 
Property Office, the property will be forwarded to the correct  usually holding a cashier's check that has been taken from 
state in the year after it is remitted to New Mexico.          the owner's account, it may be reported as follows:

May I make separate entries on my report for an owner          •    Account number 
who is due several different amounts?                          •    Plaintiff Name 
No. Please total all amounts due to each owner and enter a     •    Court Number and Reason for Action
single grand total for each owner listed on your report.       •    Name and Place of Court 
                                                               •    Defendant Name
Are Trust Accounts reportable as unclaimed property?
Trust Accounts are reportable as unclaimed or abandoned        Depending on the circumstances your information may vary; 
property in several different ways.                            please provide as much information as possible. 

(1)  If your institution is acting in a fiduciary capacity for What attempts are made to find the rightful owners?
    another person, the property is presumed abandoned         Under the law, the "holder" (banks, corporations, insurance 
    within three years after it has become payable or dis-     companies, etc.) must make an effort to find the true owners. 
    tributable. This may include intangible property and       If they are unsuccessful, they are to report the names and last 
    any income or increment derived from it (dividends,  known addresses of the owners to the Unclaimed Property 
    etc.). If the owner has increased or decreased the         Office.  The office then publishes these names in newspapers 
    principal, accepted payment of principal or income,        of general circulation around the State. If the owners see their 
    or communicated concerning the property verbally           names on the list, they should contact the Unclaimed Property 
    or in writing, the Trust Account would be considered  Office, and the claims process will begin. Unclaimed funds are 
    active.                                                    held until the owner or his/her heir(s) claim the funds.

(2)  If a fiduciary account is being held by your institution 
    but the agent or fiduciary has failed to distribute the 
    distributable principal or income or perform any of 
    the tasks outlined in (1), within five (5) years after it 
    has become payable or it is considered abandoned. 
    Although your institution is not the fiduciary, you are 
    responsible for observing the distribution dates for 
    reporting purposes.

(3)  An account established as a "trust account" under 
    terms set out in a trust agreement which conveys 
                                                              7



- 9 -
RPD-41201
Rev.03/23/2022        State of New Mexico - Taxation & Revenue Department
                                             Unclaimed Property Office
                                             P.O. Box 25123
                                    Santa Fe, New Mexico 87504-5123
                                                  505-827-0668

                      New Mexico Report of Unclaimed Property

               File on or before November 1 (May 1 for life insurance). If the due date falls on a weekend or holiday, 
                      the report is due the next business day and becomes delinquent on the first day thereafter.

PLEASE CHECK ONE:        First Filing        Annual Report 20__       Verification for Period Ended ______, 20__
                         Amended             Safety Deposit Boxes     Supplemental
Name of Holder

Address

City

Contact Person                                                        State                 ZIP Code

Federal ID Number                                                     Telephone Number
                                                                      (          )
Do any other departments, branches, or subsidiaries file reports using this same ID Number? Yes                  No

Primary Business Activity

Did you file a report of Unclaimed Property last year?  Yes           No

If no, please explain

If you are a successor, list the name(s) and Federal ID Number(s) of all previous holders of the property. If you have 
changed your name during the time in which you held the property, list the prior name(s), state of incorporation, date the 
corporation changed names and Federal ID Number(s)

               Your remittance and confirmation of shares transferred into New Mexico 
                         (if applicable) must  accompany  this report.

                                             Total amount due from last page  $
         Stock sent  to Mellon Security Trust
                                             Penalty
         Copy of Stock
                                             Interest
CUSIP Number                                 Total Remittance
Number of Shares                             Total Number of Share

                                    OFFICIAL VERIFICATION REPORT
I declare that I have examined this return and the information reported on this form and attached schedules is true and 
correct as to every material matter.
Printed Name                                            Title

Signature                                    Date                     E-mail address



- 10 -
RPD-41200
03/23/2022RETENTION PERIOD & PROPERTY TYPE CODES
CODE                        YEARS           CODE                                          YEARS CODE                         YEARS

 ACCOUNT BALANCES DUE                                       INSURANCE                           SC03  PRINCIPAL PAYMENTS 
                                                                                                     ON BONDS                  (5)
AC01  CHECKING ACCOUNTS      (5)            IN01  INDIVIDUAL POLICY/CLAIM                       SC04  EQUITY PAYMENTS          (5)
AC02  SAVINGS ACCOUNTS       (5)                 PAYMENT                                    (3) SC05  PROFITS                  (5)
AC03  MATURED CD OR                         IN02  GROUP POLICY/CLAIM                            SC06  FUNDS PAID TO PURCHASE
 SAVINGS CERTIFICATE         (5)                 PAYMENT                                    (3)      STOCK                     (5)
AC04  CHRISTMAS CLUB FUNDS   (5)            IN03  PAYMENT DUE BENEFICIARIES    (3)              SC07  FUNDS FOR STOCK/BONDS    (5)
AC05  MONEY ON DEPOSIT                      IN04  MATURE POLICY/ANNUITY                     (3) SC08  STOCK ONLY               (5)
 TO SECURE FUNDS             (5)            IN05  PREMIUM REFUNDS                           (3) SC09  CASH FOR FRACTIONAL
AC06  SECURITY DEPOSITS      (5)            IN06  UNIDENTIFIED REMIT                        (3)      SHARES                    (5)
AC07  UNIDENTIFIED DEPOSITS  (5)            IN07  DUE UNDER POLICY TERMS                    (3) SC10  UNEXCHANGED STOCK        (5)
AC08  SUSPENSE ACCOUNTS      (5)            IN08  AGENT CREDIT BALANCE                      (3) SC11  OTHER CERTIFICATE OF
AC22  IRA                    (3)            IN10  UNPRESENTED DRAFT                         (5)      OWNERSHIP                 (5)
AC99  AGGREGATE (<$50 OR                    IN99  AGGREGATE (<$50 OR                            SC12  UNDERLYING SHARES        (5)
 OWNER UNKNOWN)              (5)                 OWNER UNKNOWN)                             (3) SC13  FUNDS FOR LIQUIDATION OR
                                                                                                     REDEMPTION OF UNSUR-
                    CHECKS                                  MINERAL                                  RENDERED SHARES OR
                                                                                                     BONDS                     (5)
CK01  CASHIER'S CHECKS       (5)            MI01  NET REVENUE INTEREST                      (5) SC14  DEBENTURES               (5)
CK02  CERTIFIED CHECKS       (5)            MI02  ROYALTIES                                 (5) SC15  US GOVERNMENT SECURITIES  (5)
CK03  REGISTERED CHECKS      (5)            MI03  OVERRIDING ROYALTIES                      (5) SC16  MUTUAL FUNDS             (5)
CK04  TREASURER’S CHECKS     (5)            MI04  PRODUCTION PAYMENTS                       (5) SC17  WARRANTS (RIGHTS)        (5)
CK05  BANK DRAFTS            (5)            MI05  WORKING INTEREST                          (5) SC18  MATURED BOND PRINCIPAL   (5)
CK06  WARRANTS               (3)            MI06  BONUSES                                   (5) SC19  DIVIDEND REINVESTED      (5)
CK07  MONEY ORDERS           (7)            M107  DELAY RENTALS                             (5) SC20  CREDIT BALANCES          (5)
CK08  TRAVELERS CHECKS                 (15) MI08  SHUT-IN ROYALTIES                         (5) SC21  MISC RELATED SECURITIES  (5)
CK10  EXPENSE CHECKS         (5)            MI09  MINIMUM ROYALTIES                         (5) SC22  OTHER SECURITIES         (5)
CK11  PENSION CHECKS         (3)            MI22  OTHER MINERAL PROCEEDS                    (5) SC23  STOCK & DIVIDENDS        (5)
CK12  CREDIT CHECK/MEMO      (3)            MI99  AGGREGATE (<$50 OR                            SC24  BOND/COUPON              (5)
CK13  VENDOR/EXPENDITURE     (5)                 OWNER UNKNOWN)                             (5) SC25  CASH IN LIEU OF SHARES   (5)
CK14  CHECKS WRITTEN OFF                                                                        SC99  AGGREGATE (<$50 OR
             INCOME          (5)                 MISCELLANEOUS                                       OWNER UNKNOWN)            (5)
CK15  OTHER OFFICAL CHECKS   (5)
CK16  CD INTEREST CHECKS     (5)            MS01  WAGE/PAYROLL                              (1)      SAFEKEEPING
CK22  OTHER UNCASHED CHECKS  (5)            MS02  COMMISSIONS                               (1)
CK99  AGGREGATE (<$50 OR                    MS03  WORKERS' COMPENSATION                         SD01  SAFE DEPOSIT BOX         (5)
 OWNER UNKNOWN)              (5)                        BENEFIT                             (5) SD02  OTHER SAFEKEEPING        (5)
                                            MS04  PAYMENT FOR GOOD                              SD03 OTHER TANGIBLE PROPERTY   (5)
                    COURT                        SERVICES                                   (5)
                                            MS05  CUSTOMER OVERPAYMENT                      (3)               TRUST
CT01  ESCROW FUNDS           (1)            MS06  UNIDENTIFIED REMIT                        (5)
CT02  CONDEMNATION AWARD     (1)            MS07  UNREFUNDED OVERCHARGE                     (5) TR01  PAYING AGENT ACCOUNTS    (5)
CT03  MISSING HEIR’S FUNDS   (1)            MS08  ACCOUNTS PAYABLE                          (5) TR02  UNDELIVERED/UNCASHED
CT04  SUSPENSE ACCOUNTS      (1)            MS09  ACCOUNTS RECEIVABLE                       (5)      DIVIDENDS                 (5)
CT05  OTHER COURT DEPOSITS   (1)            MS10  CREDIT BALANCE DISCOUNT                       TR03  FUNDS HELD IN A FIDUCIARY
CT06  GARNISHMENTS           (1)                        DUE                                 (5)      CAPACITY                  (5)
CT07  BAIL OR BOND           (1)            MS11  REFUNDS DUE                               (3) TR04  ESCROW ACCOUNT           (5)
CT08  INMATE ACCOUNTS        (1)            MS12 GIFT CERTIFICATES (If redeemable               TR05  TRUST VOUCHER            (5)
CT99  AGGREGATE (<$50 OR                                  in merchandise only, report 60%       TR07  TRUST FUND               (5)
 OWNER UNKNOWN)              (1)                         of face value.)                    (5) TR22  TRUST CHECK              (5)
                                            MS13  LOAN COLLATERAL                           (5) TR99  AGGREGATE (<$50 OR
          GOVERNMENT                        MS14  PENSION/PROFIT SHARE                               OWNER UNKNOWN)            (5)
                                                 PLANS (IRA, KEOGH)                         (3)
GT01  PROPERTY TAX                          MS15 DISSOLUTION/LIQUIDATION                                   UTILITIES
             OVERPAYMENTS    (1)                 PROCEEDS                                   (1)
GT02  EXCESS PROCEEDS FROM                  MS16 MISC. OUTSTANDING CHECK                    (5) UT01  UTILITIES DEPOSIT        (1)
             TAX SALES       (1)            MS17 MISC. INTANGIBLE PROP                      (5) UT02  REFUND OR REBATE         (1)
GT03  STATE TAX REFUNDS      (1)            MS18 SUSPENSE LIABILITIES                       (5) UT99  AGGREGATE (<$50 OR
GT04  OTHER STATE WARRANTS   (1)            MS99 AGGREGATE (<$50 OR                                  OWNER UNKNOWN)            (1)
GT05  GROSS RECEIPTS WARRANTS  (1)               OWNER UNKNOWN)                             (5)
GT99  AGGREGATE (<$50 OR                                                                             OTHER PROPERTY
 OWNER UNKNOWN)              (1)                            SECURITIES
                                                                                                ZZZZ  PROPERTY NOT IDENTIFIABLE
                                            SC01 DIVIDENDS ONLY                             (5)
                                            SC02 INTEREST ON BONDS                          (5)

                                                                         9



- 11 -
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Type                                                                                 Code                                        (8)
                                                                                                                                                                                                                                                                                                                                                                                                   Property

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              (7)
                                                                                                                                                                                                                                                                                                                                        Amount                                                                                                                                                                                                                            Dividends                                 + Interest)
                                                                                                                                                                                                                                                                                                                                                                                                                                       (Principal + 

                                                                                                                                                                                                                                                                                                                                                                                                   Rela-                                                                                             tion                                                                                      Code                                        (6)       

                                                                                                                                                                                                                                                                                            (MM/DD/YY)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               (5)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     TOTAL             of  Col.  #7
                                                                                                                           Federal ID Number                                                                                                                                                                                                                                                                                                        Transaction
                                                                                                                                                                                                                                                                                                                                               Date of Last 
                                                                                                                                                                                                                                                                   
                                                                                                                                                     Period Covered
                                                                                                                                                                                                                                                                   
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  (4)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Policy No.
                                                                                                                                                                                                                                                                                                                                                            Owner’s Acct. No.,                                                                                 Certificate No., or 

                                                                                                                                                                                                                                                                  (MM/DD/YY) 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               No.                                      (3)

                                                                                                                           Report Year                                                                                                                                                                                                                                         Social Security No.                                                                                 or Federal Tax ID 
                                                                                                                                                                                From: ________________________                   To: ____________________________                                                         E-mail Address

                                                                                                                                                                        ZIP Code
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     (2)

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Number & Street                                                                      City, State, ZIP
                                                                                                                                                                                                                                                                                                                                                                                                                     Last Known Address
          State of New Mexico - Taxation & Revenue Department                                                                                                                                                                                                                                         Daytime Phone Number

                                                              LIST OF OWNERS OF UNCLAIMED PROPERTY                                                                 State

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 (1)

                                                                                                                                                                                                                                                                                                                                                                                                           Owner Name

RPD-41202 Rev. 2/4/2014                                                                            Page No._____ of ______ Holder (Name of Business) Address                     City                                                                                                                  Contact Name                                                                                                                                                                                             Last                         First                  Middle



- 12 -
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Retention Period & Property Type Codes

                                                                                                                                                                                                                                                                                                                                                                                                                                                                             e of insured and beneficiary accounts, if a single item has two 

                                                                                                          consecutively. The identification number is required for money orders and                                                                                           travelers checks.                                                                                                                                                                              (C) In the cas                                                                                                  or more owners and the addresses are the same, list both the names and ad-                                                                                dresses in one block. If addresses are different, list in two separate blocks.                                                                           When listing in two separate blocks, show amount owned to first owner and show $0 for second owner.                                                                                                                                                                                                                                                                           payee or trustee as shown on your records, even though mail has been returned from such address. If the address is unknown, enter “Unknown”.                                                                                                                                                                                                                                                                                                                                                                                            of each owner of the funds or Federal Tax ID Number (if business).                                                                                                                                                                                                                                                                       numbers of the unclaimed funds submitted. For example, owner account                                                                   numbers, check numbers, account certificates or insurance policy numbers.                                                                                                                                                                                                                                                   deposit or withdrawal made by the owner.  The “date property became pay- able, demandable, or distributable,” is, for example, the date a dividend be-                                                                                   came payable, the note became payable, the date a check or draft was issued.                                                                                                          If payable on demand, the date the instrument was issued should be used.                                                                             For savings certificates with an automatic rollover, use the date following                                                                              the first maturity. The date of computer conversion or crediting of interest                                                                                            or dividends by the holder shall not be used as the date of last transaction.                                                                                                                                                                                                                                          Relation Code: For each name listed, indicate Sole Owner - SO;  Benefi                                  ciary - BF; or Joint - JT.                                                                                                                                                                                                                                                                                         accrued interest, dividends, profit distribution, payment on principal or other                                                                            sum held or owed to the owner less any lawful claims.                                                                                                                                                               scription of funds as listed under                                                                                    on page 11.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     :   Last Known Address:  Enter last known address of the owner, beneficiary,                                                                                                                                                                                                                                                                                                                                                                                                                                       :   Social Security No. or Federal Tax ID No.: Enter Social Security Number                                                                                                                                                                                                      :   Owner’s Acct. No., Certificate No., or Policy No.: Enter any identifying                                                                                                                                                                                                                                                                                                                                                                                                           :   Date of Last Transaction: The “Date of Last Transaction” is that of the last                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              :                                                                                                                                                                                                                                                       :    Amount (Principal + Dividend + Interest): The unclaimed amount includes                                                                                                                                                                                                                                                                                                                                     :  Property Type Codes: Enter the proper type code corresponding to the de-

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Column 2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Column 3                                                                                                                                                                                                                                                                          Column 4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Column 5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Column 6                                                                                                                                                                                                                                                                                                                           Column 7                                                                                                                                                                                                                                                                                                                                                                                                       Column 8
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
                                                                                                                                                                                                                                                                                                                                                       List of Own-

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             New Mexico Report of Unclaimed 

                                                                                                                                                                                                                                                                                                                                                                                                                                . This form is to be completed and returned 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          or cashiers checks, use one block to list the 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        List of Unclaimed Contents of Safe Deposit Boxes or 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           : Complete the holder information on the top of the form to 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                : Total of individual owner accounts having identifiable owner                                                                                                                                                                                                                                                                                                                                           : Total and list all unknown accounts where there is no identify-
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          porting certified 
                                                     INSTRUCTIONS FOR LIST OF OWNERS OF UNCLAIMED PROPERTY

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         : Form RPD-41202 pages should be numbered consecutively (e.g., page 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     name or initial. Use one block for each owner’s name. If there is joint owner-                                                                              ship of the securities, list both names within the same block. If owner name                                                                        is unavailable, enter “Unknown”.                                                                         (A) If a single item has two or more owners, the names and addresses of                                                                                       all must be shown along with the relationship (e.g., “Trustee”, “or”, “and”,                                                                                 etc.). If the owners have the same address, the address may be entered one                                                       time next to the first name.                                                                                    (B) When re                                                                             names and addresses of both the remitter and the payee, specifying each. If                                                                              addresses of the remitter and payee are different, use two different blocks, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            :   Owner Name (list alphabetically): Enter owner’s last name, first name, middle 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ,  and Form RPD-41204, 

RPD-41202 Rev. 2/4/2014                                                                                                                                                             This form is used to report individual cash and cash-related items of unclaimed property.                                                                          Stocks, bonds and other securities are to be reported on Form RPD-41203, ers of Unclaimed Stocks and Other Securities                                                                 with the other reporting forms, Form RPD-41201,                                                                            Property                                                                                                                                                      Other Safekeeping Repositories.                                                                                                                                               Items of unclaimed funds must be identified by the categories described on Form RPD-41201. The exact Property Type Code and Description are to be used when com-                                                                                       pleting this form.                                                                                                                                                                                                          HOLDER INFORMATION                                                                                        include: name, address, reporting year, period covered, Federal Tax ID Number, contact                                                                                      person, phone number and E-mail address.                                                                                                                                        PAGE NUMBER                                                                                            1 of  24; 2 of  24) at the top of the form. Page totals are to be entered on each page and                                                                      the grand total for column  7 should be entered on the last page.                                                                                                                                          AGGREGATE AMOUNT                                                                                           information with a value less than $50.00, must be report individually,                                                                                                                                                                                                                         UNKNOWN ACCOUNTS                                                                                            ing owner information (e.g., no name, address, social security number or other identifying                                                                          number) regardless of amount.                                                                                                                                                                                                                                                                                                                                                                       Column 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     



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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Owner                                                                       Class                                                                                    Code                                            (9)

                                                                                                                                                                                                                                                                                                                                                                                                                     Prop-                                                                                                                                                                                                                       Code                                        (8)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                erty Type 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       (7)
                                                                                                                                                                                                                                                                                                                                                                                                                            Description                                                                            of Securities

                                                                                                                                                                                                                                                                                                                                                             (MM/DD/YY)
                                                                                                                                                                                                                Federal ID Number                                                                                                                                                                                                                                                                                                                                                                                                                                                         (6)
                                                                                                                                                                                                                                                                                                                                                                                                                                        Date of Last                                                                            Transaction
                                                                                                                                                                                                                                                                                                                                    
                                                                                                                                                                                                                                  Period Covered                                                                                                                                                                                                                                                                                                                                                                                                                                    (5)
                                                                                                                                                                                                                                                                                                                                                                                                                     Number                                                                               of Shares

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 No.                                            (4)
                                                                                                                                                                                                                                                                                                                                   (MM/DD/YY) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                               Social Security No.                                                         or Federal Tax ID 

                                                                                                                                                             Report Year                                                                         From: ________________________                   To: ____________________________                                                                     E-mail Address

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         (3)

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Number & Street                 City, State, ZIP
                                                                                                                                                                                                                                                      ZIP Code                                                                                                                                                                                                 Last Known Address

          State of New Mexico - Taxation & Revenue Department                                                                                                                                                                                                                                                                                                                      Daytime Phone Number

                                                                                                                                                                                                                                                 State

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   (2)
                                                                                                                                                                                                                                                                                                                                                                                                                                                     Owner Name

                                                                              LIST OF OWNERS OF UNCLAIMED STOCKS AND OTHER SECURITIES
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Last                      First                Middle

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 (1)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Issuer / 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   CUSIP No.
RPD-41203                                                     Rev. 03/23/2022                                                        Page No._____ of ______                          Holder (Name of Business)                   Address        City                                                                                                                  Contact Name



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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               .

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Underlying shares or other outstand-                                                                                                                                          ing certificates of ownership (5)                                          Funds for liquidation/redemption                                   of unsurrendered stocks and bonds                                                                                                                  (5)                                                                                                  Debentures (5)                                                                                                                                    U.S. government securities                                         Matured funds (5)                          Warrants (5)                                                                                                                 Matured principal on registered                                                                                                                 bonds (5)                                                                                                                                                 Dividend reinvestment plans (5)                                   Credit balances (5)                                     Aggregate securities - related cash                                                                                                           less than $50 (5)

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         SC12                                                                                                                                                                                                                                                     SC13                                                                                                                                                                                                                                                                                                                       SC14                                                                                                                                              SC15                                                               SC16                                       SC17                                                                                                                         SC18                                                                                                                                                                                                                                                                                                      SC19                                                              SC20                                                    SC99 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         -
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            P.O. Box 25123                                                                                                                                                505-827-0668

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      PROPERTY TYPE CODES                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Unclaimed Property Office
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Santa Fe, New Mexico 87504-5123

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        New Mexico Taxation & Revenue Department

                                                                                                                                                                                                                                                                                                                                                                                  curities report on this form. The number to the right of the property type                                                                                          indicates the number of years of inactivity after which the account should                                                                                be reported as unclaimed.
                                                                                                           :   Property Type Codes: The property type codes MUST be listed for all se-                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 :  Owner Class Code: Enter the following codes: SO - Sole Owner; JT - Joint                                               
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Dividends (5)                                                                                                                                                            Interest payable on registered                                                                              bonds (5)                                                           Principal payments (5)                                                                                           Equity payments (5)                                                                                       Profits (5)                                                                                                                                       Funds paid toward the purchase                                      of shares or interest in a financial      or business organization (5)                                                                                                                            Bearer bond interest and matured                                                                                principal (5)                                                                                                                                                  Shares of stock (5)                                               Cash for fractional shares (5)                                                         Unexchanged stock of successor                                                                                             corporation (5)                                                                             Any other certificates of owner                              ship (5)

                                                                                                           Column 8                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           SC01                                                                                                                                                                     SC02                                                                                                                                                                            SC03                                                                                                             SC04                                                                                                      SC05                                                                                                                                              SC06                                                                                                                                                                                                                                                                  SC07                                                                                                                                                                                                                                                                           SC08                                                              SC09                                                                                   SC10                                                                                                                                                                                                                   SC11                                                                                                                                                                                                                                                                                    Column 9                                                                                     Owner; B - Beneficiary.                                                                           You may photocopy this form as needed to complete your annual report                                                                                If you have any questions concerning your reporting obligations, please contact the Un                                                                            claimed Property Office at:

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   List of 

                                   INSTRUCTIONS FOR LIST OF OWNERS OF 
                                                                      UNCLAIMED STOCKS AND OTHER SECURITIES

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         . 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          : Complete the holder information on the top of the form to 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            If more than one issuer is being reported, list the issuers’ names in alphabeti-                                                                          cal order. Account number or Certificate Number: Enter CUSIP and account                                     number for certificate report.                                                                                                                                                                                                                                          name or initial. Use one block for each owner’s name. If there is joint owner-                                                                              ship of the securities, list both names within the same block. If owner name                                 is unavailable, enter, “Unknown”.                                                                                                                                                                                                                                        cords, even though mail has been returned from such address. If the address                                 is unknown, enter “Unknown”.                                                                                                                                                                                                                                     each owner of the funds or Federal Tax ID Number (if business).                                                                                                                                                                                                                                                                                                                                                                  able, redeemable or returnable. For reportable shares from stock dividends                            and stock splits, provide the date payable. For unexchanged shares of a suc- cessor corporation, provide the effective date when shares of the merged/                                                                               acquired corporation where exchanged. If the security is an underlying share,                                                                             enter the issue date of the earliest uncashed dividend check as the date of                last transaction.                                                                                                                                          such as common, preferred or registered bond.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              :    Issuer/CUSIP No.: Enter the name of the entity which issued the securities.                                                                                                                                                                                                                                                                                                                                                                                                                 :     Owner Name (list alphabetically): Use owner’s last name, first name, middle                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 :   Last Known Address: Report last known address of the owner on your re-                                                                                                                                                                                   :    Social Security No. or Federal Tax ID No.: Enter Social Security Number of                                                                                                                                                                                                                                                         :   Number of Shares: Indicate the number of shares owned by each owner.                                                                       :   Date of Last Transaction: Enter the date on which the property became pay-                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         :    Description of Securities: Identify the securities being reported by type class, 

RPD-41203 Rev. 03/23/2022                                                                                  Use this form to report all classes of stocks and undeliverable, unexchanged, underly-                                                                                         ing,  and other presumed unclaimed securities. Unclaimed securities should be listed in                                                                                   alphabetical order by issuer name, including CUSIP number or account number. Cash                                                                              dividends and other cash related items are to be reported on Form RPD-41203,                          Owners of Unclaimed Property                                                                                 HOLDER INFORMATION                                                                                        include: name, address, reporting year, period covered, Federal Tax ID Number, contact                                   person, phone number and E-mail address.                                                                                                                                                                                                              Column 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Column 2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Column 3                                                                                                                                                                                                                                                                                                                                     Column 4                                                                                                                                                                                                                                                Column 5                                                                                                                                       Column 6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Column 7



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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                (6)

                                                                                                                                                                                                                                                                                                                                                    Description of Articles

                                                                                                                                                                                                                                                                                                    (MM/DD/YY)

                                                                                                                                                Federal ID Number                                                                                                                                                                               No.                                                           of                                                                                                                                                                         (5)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Items

                                                                                                                                                                          Period Covered
                                                                                                                                                                                                                                                                           
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               (4)

                                                                                                                                                                                                                                                                                                                                                                           Safe Deposit Box                                        or Identifying No.

                                                                                                                                                                                                                                                                          (MM/DD/YY) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     No.                                    (3)

                                                                                                                                                                                                                                                                                                                                                    Social Security No.                                          or Federal Tax ID 
                                                                                                                                                Report Year                             From: ________________________                   To: ____________________________                                                         E-mail Address

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      (2)
                                                                                                                                                                                             ZIP Code
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Number & Street                 City, State, ZIP
                                                                                                                                                                                                                                                                                                                                                                                            Last Known Address

          State of New Mexico - Taxation & Revenue Department                                                                                                                                                                                                                                                 Daytime Phone Number
                                                                                                               OR OTHER SAFEKEEPING REPOSITORIES
                                                                                                                                                                                        State

                                                              LIST OF UNCLAIMED CONTENTS OF SAFE DEPOSIT BOXES 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   (1)

                                                                                                                                                                                                                                                                                                                                                                                            Owner Name

RPD-41204 Rev. 03/23/2022                                                                                      Page No._____ of ______          Holder (Name of Business) Address       City                                                                                                                  Contact Name                                                                                                                           Last                                 First                           Middle



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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              P O Box 25123                                                                                                                                                      505-827-0668

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Unclaimed Property Office

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Santa Fe, New Mexico 87504-5123
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              NOTE:  When addressing, specify the attention of the 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        New Mexico Taxation & Revenue Department
                                                                                                                                                                                                                                                                                                               reportable items found in the box. If reporting stock, include                                                                                    the registered owner’s name, issuing company and number of               shares. If reporting currency (foreign and domestic), list ac-                                                             cording to monetary denomination, with the total cash value                                                               recorded. Example: 10 (ten) $1.00 (one dollar) bills = $10.00.
                                                                                                                                                             : Description of Articles:  Enter a complete description of all 

                                                                                                                                                                                                                             Column 6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       If there are no contents in the box, do not report owner information.                                                                              We suggest you deliver your safe deposit box contents by courier service. If                                                                              you choose to use the U.S. Postal Service, be sure to request return receipt                                            to verify delivery.                                                                                                                                                          Unclaimed Property Office.                                You may photocopy this form as needed to complete your annual report                                                                                                      If you have any questions concerning your reporting obligations, please                                                                                                                      contact the Unclaimed Property Office at:
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
                                           INSTRUCTIONS FOR LIST OF UNCLAIMED CONTENTS
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               : Complete the holder information on the top 

                                                                                                      OF SAFE DEPOSIT BOXES OR OTHER SAFEKEEPING REPOSITORIES

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         first name, middle name or initial. Use one block for each                                                              owner’s name. If there is joint ownership of the securities,                                                         list both names within the same block. If owner name is                            unavailable, enter “Unknown”.                                                                                                                                                                            on your records, even though mail has been returned from                                                                                                                                     such address. If the address is unknown, enter “Unknown”.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               : Owner Name (list alphabetically): Enter owner’s last name,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  :  Last Known Address:  Enter last known address of the owner                                                                                                                                                                                                                                                                                              : Social Security No. or Federal Tax ID No.: Enter Social                                                                                                                                                                                                                                                                                                                                                      Security Number of each owner of the funds or Federal Tax                                                                                                                                                ID Number (if business).                                                                : Safe Deposit Box or Identifying No.:  Enter the safe deposit                                                                                           :  No. of Items:  List the number of items.

RPD-41204                                                                             Rev. 03/23/2022                                                        Every holder maintaining safe deposit boxes or other safekeeping reposi-                                                                          tories in the State of New Mexico shall report to the Unclaimed Property                                                                          Office with an inventory of property in its possession which constitutes unclaimed property under Section [7-8A-3-NMSA 1978].                                                                                                                                                                                                                                                               HOLDER INFORMATION of the form to include: name, address, reporting year, period covered, Fed- eral Tax ID Number, contact person, phone number and E-mail address.                                                                                                                                                                      Column 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Column 2                                                                                                                                                                                                                                                                                                                                                                                                                                                           Column 3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Column  4                                 box or other safekeeping identification number.                                            Column 5



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RPD-41205
Rev. 03/23/2022   State of New Mexico - Taxation & Revenue Department
                  Unclaimed Property Office
                  P.O. Box 25123
                  Santa Fe, New Mexico 87504-5123
                  505-827-0668

                  HOLDER'S NEGATIVE REPORT

Name of Holder

Address

City                                             State               ZIP Code

Federal ID Number                          Telephone Number
                                           (       )
E-mail Address

The above named holder has no unclaimed property to file with the State of New 
Mexico for the ____________ Annual Report Year of the Period Ending June 30, 
____________.

I declare that I have examined this report and, to the best of my knowledge and 
belief, it is true, correct and complete.

Printed Name                                     Title

Signature                                        Date



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                                                                                                                                                                                                                                                                                                                                                                                                    ) 
                                                                                                                                                                                                                             ZIP Code

                                                                                                                                                                                                                                                                                                                                                                Dollar Amount/Number of Shares 
                                                                                                                                                                                                                                                                                                                                                                                                    s listed on Report

                                                                                                                                                                                                                                                                                                                                                                                                   *

                                                                                                                                                                                                                             State                     Contact Phone Number

                                                                                                                                                                                                                                                                                                                                                                                                    Owner’s Address (a

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Total Request for Reimbursement: $_______________
                                                                                                                                                                                                                                                                                                                                                                Date Pd. to Owner/Acct. Reactivated

                                                                                                                                                                                                                             City                                          Contact E-mail Address                           ) 

                                                                                                                                                                                                                                                                                                                                                                                                                        Claimant’s Name & Address (if different than owner) 

State of New Mexico - Taxation & Revenue Department                                                State of ________________ Report Year ________________ Report Total________________                                                                 Contact Name
                                                                                                                                                                                                                                                                                                                            f aggregate-specify                                                     )                                                                                                                                                                                                                                      I, ______________________________, a dully authorized representative of the holder listed above, do hereby certify                                                                                                                          that the above listed funds, or other property which was listed in the Report filed by the holder, have been paid to the                                        rightful owner(s) or their appointed representatives. I agree, upon payment of the above-described property, to indem                                                                                                                       nify the State and hold it harmless for all claims and losses, demands, costs, and other expenses which the State may                                                                                                                         sustain by reason of returning property to the holder and by reason further of its refusal to pay the property to other                                   person or persons:                                                  Name and Title of Holder Representative (type or print)________________________________________________                                                                                                   Signature of Holder Representative_____________________________________________Date_______________
                                                                 HOLDER'S REQUEST FOR REIMBURSEMENT

                                                                                                                                                                                                                             Address
                                                                                                                                                                                                                                                                                                                                                                                                    exactly as on Report
                                                                                                                                                                                                                                                                                                                            Acct. Reference No. (i

                                                                                                                                                                                                                                                                                                                                                                                                    Owner’s Name (

                                                                                                                                                                                                                                                                                                                                                                                                                                                                            IF AMOUNT WAS REMITTED IN ERROR, ATTACH 
RPD-41206                                           Rev. 03/2011                                                                                                                       PART I HOLDER INFORMATION             Holder Name               Tax ID#             Contact Fax Number     PART II CLAIM INFORMATION                       Property Code                                                                                                                                                     *                                                   A SEPARATE SHEET DETAILING THE ERROR PART III HOLDER CERTIFICATION                                                                                                                                                                                                                                                                                                                                                                      Sworn to and subscribed before me this                                                                                                                       ____________day of __________20__                                                                                                                                                                                                                                                                                                                                                                                                                                                           Notary:__________________________                                   My commission expires:____________






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