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

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Retention Period & Property Type Codes

                                                                                                                  (C) In the case of insured and beneficiary accounts, if a single item has two                                                                                      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-

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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Column 6                                                                                                                                                                                                                                                                                                                   Column 7                                                             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                                                                                                                                                                                                                                                                                     List of Own-

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        New Mexico Report of Unclaimed 

                                                                                                                                                                                                                                                                                                                                                                                                                                               . This form is to be completed and returned 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  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-
                                                     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 reporting certified or cashiers checks, use one block to list the                                                                             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,                                                                           consecutively. The identification number is required for money orders and                  travelers checks.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           :   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 completing 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