RPD-41204
Rev. 02/27/2024                       New Mexico Taxation and Revenue Department
                            List of Unclaimed Contents of Safe Deposit Boxes or Other Safekeeping Repositories
                                                         Unclaimed Property Office 
                                                         P.O. Box 25123 
                                                         Santa Fe, New Mexico 87504-5123
Page No ________ of ________

Section 1
1. Name of Holder                                                         2. Period Covered

3. Report Year                     4. FEIN, SSN, or ITIN                  From:                                  To:
                                                                                         MM/DD/CCYY                       MM/DD/CCYY
Section 2
                Column 1              Column 2                                  Column 3     Column 4            Column 5 Column 6
                Owner Name            Last Known Address                  FEIN, SSN, or ITIN Safe Deposit Box or Number   Description of Articles
                                                                                             Identifying Number  of Items
Last            First       Middle    Number & Street City, State Zip Code

RPD-41204
Rev. 02/27/2024                      New Mexico Taxation and Revenue Department
   List of Unclaimed Contents of Safe Deposit Boxes or Other Safekeeping Repositories 
                                                        Instructions
This form is used to report individual cash and cash-related        Column 4: Safe Deposit Box or Identifying Number
items of unclaimed property. Stocks, bonds and other securi-                   Enter the safe deposit box or other safekeeping 
ties are to be reported on Form RPD-41203, List of Owners                      identification number.
of Unclaimed Stocks and Other Securities. This form is to be        Column 5:  Number of Items
completed and returned with the other reporting forms, Form                    List the number of items.
RPD-41201, New Mexico Report of Unclaimed Property, and             Column 6: Description of Articles
Form RPD-41204, List of Unclaimed Contents of Safe Deposit                     Enter a complete description of all reportable 
Boxes or Other Safekeeping Repositories.                                       items found in the box. If reporting stock, include 
                                                                               the registered owner’s name, issuing company 
Items of unclaimed funds must be identified by the categories                  and  number  of  shares.  If  reporting  currency 
as listed on the Retention Period and Property Type Codes                      (foreign and domestic), list according to mon-
Schedule. The exact Property Type Code and Description are                     etary denomination, with the total cash value 
to be used when completing this form.                                          recorded. Example: 10 (ten) $1.00 (one dollar) 
                                                                               bills = $10.00.
Page Number     Pages should be numbered consecutively 
(e.g., page 1 of  24; 2 of  24) at the top of the form.             If there are no contents in the box, do not report owner in-
                                                                    formation. 
Section 1
1.  Name of Holder                                                  We suggest you deliver your safe deposit box contents by 
   Enter the name of the holder.                                    courier service. If you choose to use the U.S. Postal Service, 
2.  Period Covered                                                  be sure to request return receipt to verify delivery. NOTE:  
   Enter the period covered by the report in the from and to        When addressing, specify the attention of the Unclaimed 
   lines. Use the date format mm/dd/ccyy.                           Property Office. 
3.  Report Year
   Enter the                                                        You may photocopy this form as needed to complete 
4.  FEIN, SSN, or ITIN                                              your annual report. 
   Enter the FEIN, SSN, or ITIN of the holder.
                                                                    If you have any questions please contact the Unclaimed 
Section 2                                                           Property Office at: 
Aggregate Amount: Total  of  individual  owner  accounts 
having identifiable owner information with a value less than         New Mexico Taxation & Revenue Department 
$50.00, must be report individually,                                           Unclaimed Property Office 
                                                                                        P O Box 25123 
Unknown Accounts: Total and list all unknown accounts                          Santa Fe, New Mexico 87504-5123 
where there is no identifying owner information (e.g., no name,                Unclaimed.Property@tax.nm.gov
address, social security number or other identifying number)                            505-827-0668
regardless of amount.

Column 1:  Owner Name
                List alphabetically. Enter owner’s last name, 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 “Un-
                known”.
Column 2:  Last Known Address
                Enter last known address of the owner, benefi-
                ciary, payee or trustee as shown on your records, 
                even though mail has been returned from such 
                address. If the address is unknown, enter “Un-
                known”.
Column 3:  FEIN, SSN, or ITIN
                Enter the FEIN, SSN, or ITIN of each owner of 
                the funds.