RPD-41203
Rev. 02/27/2024                                New Mexico Taxation and Revenue Department
                                        List of Owners of Unclaimed Stocks and Other Securities
                                                           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    Column 7      Column 8Column 9
Issuer/ CUSIP               Owner Name                     Last Known Address             FEIN, SSN, or ITIN Number  Date of Last Description  Property  Owner 
   Number                                                                                                    of       Transaction of Securities Type Class 
                                                                                                             Shares                             Code Code
                Last        First       Middle Number & Street City, State Zip Code

                                                                                                                Total of Column 5

                                                                                                                Total of All Pages

RPD-41203
Rev. 02/27/2024                  New Mexico Taxation and Revenue Department
                          List of Owners of Unclaimed Stocks and Other Securities
                                                  Instructions
Use this form to report all classes of stocks and undeliver-                 provide the date payable. For unexchanged 
able,  unexchanged,  underlying,  and  other  presumed  un-                  shares of a successor corporation, provide the ef-
claimed securities. Unclaimed securities should be listed in                 fective date when shares of the merged/acquired 
alphabetical order by issuer name, including CUSIP number                    corporation where exchanged. If the security is 
or account number. Cash dividends and other cash related                     an underlying share, enter the issue date of the 
items are to be reported on Form RPD-41203, List of Owners                   earliest uncashed dividend check as the date of 
of Unclaimed Property.                                                       last transaction.
                                                                   Column 7: Description of Securities
Page Number Pages should be numbered consecutively                           Identify the securities being reported by type 
(e.g., page 1 of  24; 2 of 24) at the top of the form. Page totals           class, such as common, preferred or registered 
are to be entered on each page and the grand total for column                bond.
5 should be entered on the last page.                              Column 8: Property Type Codes
                                                                             Enter the proper property type code correspond-
Section 1                                                                    ing to the description of funds as listed on the 
1.  Name of Holder                                                           Retention Period and Property  Type Codes 
  Enter the name of the holder.                                              Schedule. The property type codes MUST be 
2.  Period Covered                                                           listed for all securities report on this form. The 
  Enter the period covered by the report in the from and to                  number to the right of the property type indicates 
  lines. Use the date format mm/dd/ccyy.                                     the number of years of inactivity after which the 
3.  Report Year                                                              account should be reported as unclaimed.
  Enter the report year applicable to this report.
4.  FEIN, SSN, or ITIN                                             Column 9: Owner Class Code: Enter the following codes: SO 
  Enter the FEIN, SSN, or ITIN of the holder.                                - Sole Owner; JT - Joint Owner; B - Beneficiary.

Section 2                                                          You may photocopy this form as needed to complete 
Column 1:  Issuer/CUSIP Number                                     your annual report.
                Enter the name of the entity which issued the 
                securities. If more than one issuer is being re-   If you have any questions please contact the Unclaimed 
                ported, list the issuers’ names in alphabetical    Property Office at:
                order. Account number or Certificate Number: 
                Enter CUSIP and account number for certificate          New Mexico Taxation & Revenue Department
                report.                                                        Unclaimed Property Office
Column 2: Owner Name                                                                  P.O. Box 25123
                List alphabetically Use owner’s last name, first             Santa Fe, New Mexico 87504-5123
                name, middle name or initial. Use one block for              Unclaimed.Property@tax.nm.gov
                each owner’s name. If there is joint ownership of                     505-827-0668
                the securities, list both names within the same 
                block. If owner name is unavailable, enter, “Un-
                known”.
Column 3:  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 4:  FEIN, SSN, or ITIN
                Enter the FEIN, SSN, or ITIN of each owner of 
                the funds.
Column 5:  Number of Shares
                Indicate the number of shares owned by each 
                owner.
Column 6:  Date of Last Transaction
                Enter the date on which the property became 
                payable, redeemable or returnable. For report-
                able shares from stock dividends and stock splits,