PDF document
- 1 -
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Owner                                                                       Class                                                                                    Code                                            (9)

                                                                                                                                                                                                                                                                                                                                                                                                                     Prop-                                                                                                                                                                                                                       Code                                        (8)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                erty Type 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       (7)
                                                                                                                                                                                                                                                                                                                                                                                                                            Description                                                                            of Securities

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

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

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

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         (3)

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

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

                                                                                                                                                                                                                                                 State

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   (2)
                                                                                                                                                                                                                                                                                                                                                                                                                                                     Owner Name

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

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



- 2 -
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               .

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

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

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

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         New Mexico Taxation & Revenue Department

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

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

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   List of 

                                   INSTRUCTIONS FOR LIST OF OWNERS OF 
                                                                      UNCLAIMED STOCKS AND OTHER SECURITIES

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

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

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






PDF file checksum: 255387669

(Plugin #1/9.12/13.0)