(6)

                                                                                                                                                                                                                                                                                                                                                    Description of Articles

                                                                                                                                                                                                                                                                                                    (MM/DD/YY)

                                                                                                                                                Federal ID Number                                                                                                                                                                               No.                                                           of                                                                                                                                                                         (5)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Items

                                                                                                                                                                          Period Covered
                                                                                                                                                                                                                                                                           
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               (4)

                                                                                                                                                                                                                                                                                                                                                                           Safe Deposit Box                                        or Identifying No.

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

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

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

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

                                                              LIST OF UNCLAIMED CONTENTS OF SAFE DEPOSIT BOXES 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   (1)

                                                                                                                                                                                                                                                                                                                                                                                            Owner Name

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

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       .

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              P O Box 25123                                                                                                                                                      505-827-0668

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Unclaimed Property Office

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

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

                                                                                                      OF SAFE DEPOSIT BOXES OR OTHER SAFEKEEPING REPOSITORIES

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

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