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RPD-41200
Rev. 06/17/2020

                                   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   505-827-0762

                                   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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RPD-41200
Rev. 06/17/2020

                GENERAL INFORMATION

HOW TO USE THIS MANUAL
                                                                   The Unclaimed Property Office is always available to assist 
This manual has been prepared to assist you in filing your         you with special reporting problems. When you have ques-
unclaimed property reports with the New Mexico Unclaimed           tions, please call or write for assistance.
Property Office. It does not address legal issues relating to 
unclaimed property, nor does it describe all types of property     Retention of Records
which must be reported. It will, however, provide instructions 
for reporting the more common types of abandoned property.         All holders are required to retain records of unclaimed prop-
                                                                   erty for ten (10) years. You may be contacted periodically by 
    General Information gives an overview of                       the Unclaimed Property Office to verify previously reported 
    unclaimed property reporting and provides                      information.
    basic information such as when to report.
                                                                   Notice to Owners (Due Diligence)
    The        Property Specific Reporting section 
    discusses some of the more common types                        The New Mexico Unclaimed Property Act requires you to send 
    of unclaimed property.                                         written notice to the apparent owner at the owner’s last known 
                                                                   address not more than 120 days before filing the report.
    Frequently Asked Questions from unclaimed 
    property holders, such as the bank or busi-                    Negative Reports
    ness you represent, are answered.
                                                                   If you have no unclaimed property to report, file Form RPD-
The report must be filed on or before November 1 of each           41205, Holder's Negative Report, on November 1, or May 1 
year for the twelve months next preceding July 1 of that year,     for life insurance companies.
but a report with respect to a life insurance company must be 
filed on or before May 1 of each year for the calendar year        Supplemental Reports
next preceding. Tangible property held in a safe deposit box 
or other safekeeping depository may not be delivered to the        If you find it necessary to file a supplemental report at any 
administrator until one hundred twenty (120) days after filing     time, please do not combine the report with any previously 
the report required by Section 7 of the Uniform Unclaimed          reported accounts. Prepare a new report and indicate in a 
Property Act [7-8A-1 to 7-8A-31 NMSA 1978].                        cover letter that it is a supplemental filing.

After property has been delivered to the Unclaimed Property        Computer Printouts
Office, you should refer owners to our office and we will 
handle their claim.  An option exists for you to pay the claim-    Computer listings cannot be accepted in lieu of the approved 
                                                                   reporting forms unless all required data fields are included 
ants directly, and file for reimbursement from the Unclaimed 
                                                                   on the printout. Property type codes must appear on the 
Property Office.
                                                                   printout. Refer to the forms and instructions for a listing of 
                                                                   the approved codes.
The Unclaimed Property Office’s goal is to reunite as many 
people as possible with their unclaimed property. Once you 
                                                                   Electronic Filing
have delivered your remittance to our office, owners may claim 
their property at any time thereafter; there is no time limit.     We encourage all holders to report their unclaimed property to 
                                                                   the office electronically. The Taxation and Revenue Department 
                                                                   will accept electronic data in the NAUPA (National Unclaimed 
YOUR RESPONSIBILITIES AS A HOLDER                                  Property Administrators) format only.  Effective July 1, 2006, all 
                                                                   reports containing more than 25 properties must be submitted 
The New Mexico Report of Unclaimed Property requires               in electronic format. If you would like more information about 
that you provide your Federal Tax ID, current address,             electronic reporting, please call (505) 827-0762 or visit our 
contact person,  phone number and E-mail address.                  website at www.tax.newmexico.gov.
It is your responsibility to keep this office advised of your cur-
                                                                   Additional Forms
rent address and any changes in the department responsible 
for filing your reports.  All correspondence should include your   If additional unclaimed property forms are needed, you may 
Federal Employer Identification Number (tax ID number).            photocopy the blank forms.

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RPD-41200
Rev. 06/17/2020

Aggregate Reporting
                                                                     To file for a refund, write a letter to the Unclaimed Property 
Individual owner accounts of less than $50 may be reported           Office, explain your mistake, and include an amended report. 
as aggregate. If you wish to avoid us having to contact you          Your refund will be processed within 90 days after you have 
each time an owner files a claim for under $50, you may want         satisfactorily documented the overpayment.
to list each individual separately.

Failure to Report                                                    ASSISTING CLAIMANTS

A holder who fails to report, pay or deliver property within the     Unclaimed property owners may contact you after you have 
time prescribed by the Uniform Unclaimed Property Act [7-
                                                                     remitted the property to the Unclaimed Property Office. These 
8A-1 to 7-8A-31 NMSA 1978] shall pay to the administrator 
                                                                     owners should be referred to this office. 
interest at the computed daily rate established by the U.S. 
Internal Revenue Code (IRC) on the property or value thereof 
                                                                     When the reimbursement process is not appropriate, direct 
from the date the property should have been reported, paid 
                                                                     potential claimants to contact our office to initiate a claim.
or delivered.
The IRC rate changes quarterly, and is announced by the              CALL or WRITE:     Taxation and Revenue Department
Internal Revenue Service in the last month of the previous                              Unclaimed Property Office
quarter. The annual and daily interest rate for each quarter                            P. O. Box 25123
will be posted on our website at www.tax.newmexico.gov.                                 Santa Fe, NM 87504-5123
                                                                                        (505) 827-0668, or 827-0762

FILING FOR REIMBURSEMENT AND                                         How Claims are Processed
REFUNDS
                                                                     One objective of the Unclaimed Property Office is to process 
There are two types of payments the Unclaimed Property Office        and pay all unclaimed property claims within 90 days. Claim-
will make to holders after they have remitted their unclaimed        ants are required to provide the Unclaimed Property Office with 
property. The most common type is a reimbursement; the               sufficient proof and documentation to substantiate ownership 
second type is a refund.                                             and entitlement for payment.

REIMBURSEMENT: In this process a holder decides to pay an            Proof provided by claimants is compared with owner infor-
owner and then files a claim with the Unclaimed Property Office      mation and property descriptions provided by, the reporting 
for reimbursement. We encourage you to use the reimburse-            company or institution. When preparing your report, assume 
ment process for those customers and owners demanding  each owner you list is a potential claimant. It is essential 
immediate payment or reinstatement of their accounts. We             that all available information which identifies owners 
make every effort to respond to your request as quickly as           and properties be listed on your report to the Unclaimed 
possible. To obtain reimbursement you must complete and              Property Office.
properly execute an Affidavit by Holder for Return of Property 
Presumed Unclaimed, Form RPD-41206.                                  Social security numbers, last known addresses, and property 
                                                                     descriptions are three items used to verify ownership during 
After we receive your affidavit, a check will be mailed to you       the claims process. Providing this and other descriptive infor-
approximately within 90 days.                                        mation on your report will reduce the need for the Unclaimed 
                                                                     Property Office to contact you for additional information during 
REFUND: Refunds are made to holders who have overpaid                the claims process.
their unclaimed property reports. The overpayments are usu-
ally due to accounting errors or other mistakes made during 
the preparation of reports. 

               PROPERTY SPECIFIC REPORTING
FINANCIAL INSTITUTIONS                                               property report you file with the Unclaimed Property Office. 
                                                                     The dormancy periods are determined by the property types.
Financial institutions include, but are not limited to, savings and 
loan associations, building and loan associations, industrial        DORMANCY PERIODS
banks, other banking organizations and credit unions.
When you have held unclaimed properties for the appropri-            FIVE-YEAR PROPERTIES: All types of demand deposit ac-
ate dormancy periods, include them on the next unclaimed             counts and savings accounts have five-year dormancy periods. 

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RPD-41200
Rev. 06/17/2020

Abandoned safe deposit box contents and matured certificates         included on the November 1 report. If some event such as 
of deposit are also reportable after five years of inactivity.       death of the owner occurs prior to the owner reaching age 
                                                                     70-1/2, commence the dormancy period from the date of the 
Other types of unclaimed property reportable by financial in-        owner's death.
stitutions include, but are not limited to, all types of uncashed 
checks; trust-related properties, investments and escrow ac-         Trust Properties
counts; all types of securities-related properties; other sums 
payable under pension and profit-sharing plans; safekeeping          If you have trust properties to report, remember to list ben-
properties; and miscellaneous types of unclaimed property            eficiaries of trusts as primary owners. For instance, we will 
such as unidentified remittances. See      Retention Period &        publish the names of minor children on accounts held under 
Property Type Codes.                                                 the Uniform Gift to Minors Act (UGMA). 

ONE-YEAR PROPERTIES: Employee wages - See Retention                  If the trust properties you hold are securities-related, you must 
Period & Property Type Codes.                                        complete Form RPD-41203, List of Owners of Unclaimed Stock 
                                                                     and Other Securities. Instructions for reporting these property 
Non-Return Mail                                                      types are on the back of Form RPD-41203.

The non-return of mail does not constitute activity on an  Any personal trust properties which are not securities-related 
account. In other words, you cannot assume you know the  may be reported on the regular reporting Form RPD-41202.
whereabouts of customers just because the post office did not 
return their monthly statements. When reviewing your records         If you are holding any properties in safekeeping for trust cus-
for dormant accounts, remember to look for the last debit or  tomers, you should report them in the same manner as safe 
credit generated by the owners.                                      deposit box contents. Refer to the Reporting Safe Deposit 
                                                                     Box Contents or Safekeeping Property below.
Reporting Certificates of Deposit
                                                                     Corporate Trust Properties
The dormancy period for matured certificates of deposit is 
five years. The dormancy period begins on the day following          Corporate trust properties are to be reported on Form RPD-
the first maturity of the certificates - that is, the day following  41203, List of Owners of Unclaimed Stock and Other Securi-
the end of the first term. Thus, certificates of deposit must be     ties. The following rules should be observed when reporting 
reported five years from the dates the owners were first able        corporate trust properties:
to recover the funds without penalties.
                                                                         1.  List minor children as primary owners of properties 
When remitting automatically renewable certificates of deposit,             on UGMA accounts. The trustees should be listed as 
you may hold the funds on November 1, waiting to remit on 
                                                                            additional owners.
the date of next maturity. This option is available if you wish 
to avoid charging the owners interest penalties for early with-
                                                                         2.  If you are reporting bearer bonds or unclaimed inter-
drawal under the current terms.
                                                                            est on the bonds, the owners of the properties should 
                                                                            be listed as unknown. Complete descriptions of the 
Interest earned on certificates of deposit must be reported five 
                                                                            bonds must be provided in the description field.
years from the date it was payable. However, if the owners 
instructed that interest be added to the principal amounts of 
                                                                         3.  When reporting bond interest, list all outstanding 
the certificates, the interest must be reported with the principal 
                                                                            coupon numbers in the description field.
five years from the date of first maturity.
Don’t Forget: If certificates of deposit owners have other ac-           4.  If you are reporting dividends received in nominee 
tive accounts with your institution, do not report or remit their           name, the stock issues must be listed in the descrip-
dormant certificates.                                                       tion field. The owners must be listed as unknown.

Reporting Individual Retirement Accounts                                 5.  If you are remitting underlying shares, shares returned 
                                                                            by the post office (RPO shares), or both, please  
Individual Retirement Accounts (IRAs) have a dormancy pe-                   combine all shares of the same issue and class in 
riod of three years. The dormancy period begins no later than               one certificate. Your report, however, must reflect 
the date the owner of the IRA reaches age 70-1/2 which is                   the number of shares which are underlying and the 
the mandatory distribution date under federal law. Thus, the                number which are RPO for each of the owners.
dormancy period commences the day after the owner reaches 
the age of 70-1/2 years. Any individual retirement accounts              6.  Please begin the registration change process early 
dormant for more than three years on June 30 should be                      enough so that securities are delivered to the Un-

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RPD-41200
Rev. 06/17/2020

       claimed Property Office no later than November 1.         Mail or deliver the contents to the Unclaimed Property Office on 
                                                                 your designated delivery date. Courier service is not required 
Reporting Unclaimed Loan Collateral                              but is suggested when your contents include valuables. If you 
                                                                 choose to deliver your properties by the U.S. Postal Service, 
Unclaimed loan collateral should be reported five years after  they should be sent certified, return receipt requested.
the date the loan was paid in full. It should be reported us-
ing property type codes from the back of Form RPD-41201,  Please mail to:
New Mexico Report of Unclaimed Property. When reporting 
                                                                        Taxation and Revenue Department
unclaimed loan collateral, refer to the safe deposit boxes 
                                                                        Attn: Unclaimed Property Office
instructions below.
                                                                        P. O. Box 25123
                                                                        Santa Fe, New Mexico  87504-5123
Reporting Safe Deposit Box Contents or Safekeeping 
Property  (includes unclaimed loan collateral)
                                                                 Please deliver to:
On November 1 of each year, report to the Unclaimed 
                                                                        Taxation and Revenue Department
Property Office safe deposit box contents, safekeeping 
                                                                        Unclaimed Property Office
properties, loan collateral, and any other tangible proper-
                                                                        Manuel Lujan Building
ties that have remained unclaimed by the owners for more 
                                                                        1200 South St. Francis Drive
than five years. Use Form RPD-41204, List of Unclaimed 
                                                                        Santa Fe, New Mexico  87504
Contents of Safe Deposit Boxes or Other Safekeeping Re-
positories, to report these items. This report is required by  
                                                                 For questions or assistance, please call Or visit our website at:
Section 7 of the Uniform Unclaimed Property Act (1995).
                                                                        Unclaimed Property Office                       
The five-year dormancy period for safe deposit box(es) con-             www.tax.newmexico.gov
tents begins from the date the last rental payment expired. DO          (505) 827-0668 or (505) 827-0762
NOT send the contents of safe deposit box(es) along with the 
report. You must wait 120 days after filing Form RPD-41204 
with the Unclaimed Property Office before you can deliver the    REPORTING SECURITIES OR 
items to the administrator (7-8A-8 NMSA 1978). This postmark 
date of receipt is the filing date of the report.                SECURITIES RELATED CASH
All contents MUST be inventoried and listed on Form RPD-
41204, List of Unclaimed Contents of Safe Deposit Boxes or       Securities or securities-related cash are to be reported on 
Other Safekeeping Repositories. Any items that have, or may      Form RPD-41203, List of Owners of Unclaimed Stock and 
have, a monetary value should be inventoried separately. If you  Other Securities. Instructions for completing the form are on 
have letters, slips of papers, pictures, or items of a personal  the back of Form RPD-41203.
nature, these may be inventoried together.
                                                                 General Rules for Reporting
Two copies of the inventory must accompany the contents 
of each box. Include the box or account numbers and owner            1.  Do not aggregate cash dividends or any other prop-
names on each inventory sheet, as well as the name of your              erty type which involves a periodic distribution to the 
institution. Place each original inventory inside the corre-            owner.
sponding owner envelope. Attach the second copy of the 
inventory to the outside of each box to correspond with              2.  List the minor child as the primary owner of the prop-
owner contents. Insure that your company name and report                erty on a Uniform Gift to Minors Act (UGMA) account. 
date is on the outside of each box.                                     The trustee should be listed as an additional owner.

1.  Securities - Securities include stock certificates,              3.  If you are reporting bearer bonds or unclaimed inter-
       government bonds, interest coupons, etc. When                    est on the bonds, the owner of the property should 
       describing securities-related properties, include the            be listed as unknown. A complete description of the 
       registered owners' names, issuing companies, and                 bond, including bond number, must be provided in 
       number of shares.                                                the description field.

2.  Firearms and Controlled Substances - Please ad-                  4.  When reporting bearer bond interest, the description 
       vise the Unclaimed Property Office when firearms                 field should include the outstanding coupon numbers.
       or controlled substances are enclosed prior to 
       delivery.                                                     5.  The stock issue must be listed in the description field 
                                                                        if your are reporting dividends received in nominee 

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RPD-41200
Rev. 06/17/2020

name. The owner must be listed as unknown.
                                                                      BNY Mellon/Branch Deposit Department
6.  If you are remitting underlying shares, shares returned           570 Washington BLVD-5th Floor
by the post office (RPO share), or both, please combine               Jersey City, NJ 07310
all shares of the same issue and class in one certifi-                Attn: BNY Mellon/Branch Deposit Department
cate. Your report, however, must reflect the number                            For further credit to account #822472
of shares which are underlying and the number which 
are RPO for each owner.                                               Open End Mutual Fund

7.  Please direct the appropriate transfer agent to begin  Mutual Fund Accounts held for the State of New Mexico must 
the registration process. Securities must be deliv-                   be open in advance. Avenu will provide the account numbers 
ered to Mellon Security Trust Company no later                        for all mutual funds to be transferred into the state's account.  
than November 1.                                                      Please contact  Avenu at UPCH.Custody@avenuinsights.com 
                                                                      to obtain the account numbers no later than 3 business days 
                                                                      prior to attempting delivery.
REPORTING AND DELIVERY OF 
SECURITIES PROPERTY                                                   For ALL stock and mutual fund remittances: 

Two days prior to delivery, you MUST fax 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: Vilka Markovich (Attn: Loreta Pengo if a 
All  DTC eligible shares MUST be deposited through DTC                DRP, DTC, or Mutual Fund) and to the Division of Unclaimed 
as follows:                                                           Property at (505) 827-1759. This list should include cusip 
                                                                      numbers, number of shares, issue names and if a physical 
Nominee Name:                                                         certificate, a certificate number and registration for each 
Hare & Co                                                             security to be delivered; if a DTC delivery, the delivering party’s 
FEIN: 13-6062916                                                      DTC number; and if a Dividend Reinvestment or Mutual Fund 
DTC Participant #901                                                  account, the account number and TIN for the issuer.
Agent Bank # 26500
Account # 822472                                                      Avenu will provide account numbers for all mutual funds that will 
                                                                      be transferred to the state's account. Please contact Marsela 
Register Dividend Reinvestment Plan Shares, Book Entry                Strakosha at (617) 371-9914 to obtain account numbers 48 
Shares or Direct Registration Shares as follows:                      hours prior to attempting delivery.

Nominee Name:                                                         If the fund chooses to establish new account numbers and 
Hare & Co                                                             register mutual funds as indicated below, please ensure to 
FEIN: 13-6062916                                                      provide a detailed list 48 hours in advance to UPCH.Custody@
c/o  Avenu Insight                                                    avenuinsights.com. This list should contain cusip number, 
100 Hancock Street, 10th floor                                        name of the fund, share amount and the account number 
Quincy, MA 02171                                                      at the fund. NOTE:  All new accounts should be set up with 
                                                                      Phone Privileges. 
*Please set up DRP account to allow dividends to be paid 
in cash.                                                              PROPERTY REPORTED BY INSURANCE 
A confirmation statement showing Hare & Co as the owner               COMPANIES
of the shares must accompany your Report of Unclaimed 
Property for your report to be considered complete.                   Reporting Deadlines (See     Retention Period & Property 
                                                                      Type Codes)
Register and deliver physical certificates as follows:
                                                                      "Insurance Company" means an association, corporation, or 
Certificates must be registered as shown below.  A photocopy          fraternal or mutual benefit organization, whether or not for 
of the certificate should be delivered with your report and the       profit, engaged in the business of providing life endowments, 
original certificate sent to our custodian.  Please be advised        annuities, or insurance, including accident, burial, casualty, 
that certificates registered incorrectly will be returned to you for  credit life, contract performance, dental, disability, fidelity, 
re-registration and your report will be considered incomplete.        fire, health, hospitalization, illness, life, malpractice, marine, 
Register in Nominee Name: Hare & Co, FEIN: 13-6062916.                mortgage, surety, wage protection, and workers' compensa-
Deliver certificates to:                                              tion insurance.

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RPD-41200
Rev. 06/17/2020

                                                                    REPORTING MINERAL PROCEEDS
Insurance companies reporting non-life properties should fol-
low the general guidelines for reporting. However, additional       Determining What Property to Report
information that will assist in identifying the owners should 
be listed in Funds Description. Holders must specify in the         The dormancy period for unclaimed mineral proceeds is five 
description field the types of insurance they are reporting. Use    years. Review your records as of June 30th of the current year 
the abbreviation AH for accident and health insurance and           and report all property which has not had owner-generated 
PC for property and casualty insurance.                             activity. Once an owner has been listed on a report, do not 
                                                                    include continuing payments due on the same property on 
All descriptive information listed in the description field should  reports for subsequent years.
be preceded by abbreviations which indicate what you are 
describing. Please refer to the list below.                         Aggregate Reporting of Mineral Proceeds

                                                                    Please do not aggregate amounts less than $50.00 on your 
                 ABBREVIATIONS
                                                                    report. An owner having interests in more than one well or 
   AH               Accident & Health                               lease of less than $50.00 should be listed only once on your 
                                                                    report with the net amount due for all properties combined in 
   BENF             Beneficiary                                     one total. If the net amount due an owner on all leases is 
   CK               Check                                           a negative, do not include it on your report.  

   DRFT             Draft                                           Amounts to Report
   L                Life Insurance
                                                                    The amount to be reported is the total due to the owners as 
   DOB              Date of Birth                                   of the close of business on June 30.
   ENDW             Endowment
                                                                    Other Types of Property Which Must be Reported by Oil 
   GRP              Group Policy                                    & Gas Companies
   INS              Insured
                                                                    Oil and gas companies are required to report other types of 
   MAT              Matured Policy                                  property besides mineral proceeds. The Retention Period & 
   PC               Property & Casualty                             Property Type Codes listed on page 11 should be reviewed 
                                                                    closely to determine if other types of unclaimed property are 
   PDUP             Paid-up Policy                                  held, such as securities and securities related cash, expense 
   POL              Policy Number                                   checks, vendors checks and employee wages.

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RPD-41200
Rev. 06/17/2020

               FREQUENTLY ASKED QUESTIONS
To whom do I make my remittance check payable?                   (2)  If a fiduciary account is being held by your institution 
Your remittance check should be made payable to the New               but the agent or fiduciary has failed to distribute the 
Mexico Taxation and Revenue Department, Unclaimed                     distributable principal or income or perform any of 
Property. Please prepare one check for each report you file.          the tasks outlined in (1), within five (5) years after it 
                                                                      has become payable or it is considered abandoned. 
Do I need to notarize my report?                                      Although your institution is not the fiduciary, you are 
No.                                                                   responsible for observing the distribution dates for 
                                                                      reporting purposes.
Are negative reports required?
Yes. Complete Form RPD-41205 when you have no property           (3) An account established as a "trust account" under 
to report.                                                            terms set out in a trust agreement which conveys 
                                                                      instructions for distribution at death, maturity, majority, 
What do I enter in the "Verification for Period Ended"                or some other specific distribution date is considered 
blank on Form RPD-41201?                                              abandoned five years after the date has passed if 
Enter June 30 of the current fiscal year for corporations and         there has not been any activity by the owner or his/
December 31 for life insurance companies.                             her designated representative.

I received unclaimed property reporting forms from other  Are we supposed to report garnishments? How should 
states. How should I report?                                     they be listed on the report?
Unclaimed property should be reported to the state of last known Garnishments are reported if the money was held or set aside 
address of the missing owner. If the address is unknown, the  by a "Writ of Garnishment," but no further action occurred. 
property should be reported to the state where your company      Never report a garnishment account if legal action is pending. 
is incorporated. If property with a last known address other  If no further action occurred, such as an order from the court 
than New Mexico is reported to the New Mexico Unclaimed  for the defendant to pay or a notice that the action is dissolved 
Property Office, the property will be forwarded to the correct   or terminated, then the funds should have been redeposited 
state in the year after it is remitted to New Mexico.            into the owner's account. This is the point at which an owner 
                                                                 often becomes lost. The account (check) is reportable as 
                                                                 unclaimed property one year after the last owner contact or 
Will you accept computer printouts in lieu of the approved       activity. A garnished account or an account held as a result 
reporting forms?                                                 of a "Writ of Garnishment" should be reported with as much 
Computer listings will only be accepted if all required data  information as you can provide. Since at this point you are 
fields are included on the printout. Property type codes must    usually holding a cashier's check that has been taken from 
also appear on the printout.                                     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 each owner and enter a single   •    Court Number and Reason for Action
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.

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RPD-41201
Rev. 07/15/2016       State of New Mexico - Taxation & Revenue Department
                                             Unclaimed Property Office
                                             P.O. Box 25123
                                    Santa Fe, New Mexico 87504-5123
                                    (505) 827-0762 or (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
Rev. 06/17/2020RETENTION 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



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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         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)
                                                                                                                                                                                                                                                                                                                                                                                                                           Desription                                                                            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.  2/4/2014                                                        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

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      PROPERTY TYPE CODES                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Unclaimed Property Office                                                                                                                                                                                                                                                                                            (505) 827-0767 or  827-0668
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            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.  2/4/2014                                                                                   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. 04/02/2014                                                                                      Page No._____ of ______          Holder (Name of Business) Address       City                                                                                                                  Contact Name                                                                                                                           Last                                 First                           Middle



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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 P O Box 25123

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Unclaimed Property Office
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Santa Fe, New Mexico 87504-5123                                                                                                             (505) 827-0767 or (505) 827-0668
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               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:

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   from                                                                            
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Enter 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   returned 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     No.: 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   been 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     ID 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   has 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Tax 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   mail 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Federal 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   though 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     or 
                                           INSTRUCTIONS FOR LIST OF UNCLAIMED CONTENTS
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                : Complete the holder information on the top                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       even                                                                                                                                                                                                              No. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   records, 
                                                                                                      OF SAFE DEPOSIT BOXES OR OTHER SAFEKEEPING REPOSITORIES                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Security 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   your 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          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                                                                                                               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 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. 04/02/2014                                                         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         State of New Mexico - Taxation & Revenue Department
Rev. 07/15/2016
                  Unclaimed Property Office
                  P.O. Box 25123
                  Santa Fe, New Mexico 87504-5123
                  (505) 827-0762 or 827-0668

                  HOLDER'S NEGATIVE REPORT

Name of Holder

Address

City                                             State               ZIP Code

Federal ID Number                           Telephone Number
                                            (       )
E-mail Addresss

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 knowlege 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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