Enlarge image | 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 |
Enlarge image | . 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 |