Vermont State Treasurer Office - Unclaimed Property Division 
                                                                109 State St., 4th Floor │Montpelier, Vermont 05609-6200 
 
                                                                        UNCLAIMED  ROPERTY P           EPORT  R     –SCHEDULE A 

HOLDER NAME                                                                                                            REPORT  ATED                                                                     
                                                                                                                       
HOLDER FEIN                                                                                                           FOR YEAR  NDEDE                                                                   
                                                                                                                                                                               
           Owner Information                                                                                          Property Details 
Last Name, First, Middle                           Date of Last Transaction or                                                                                                 Cash Amount 
                                     SSN/FEIN                                              Account No. NAUPA Owner    NAUPA Owner        NAUPA        Cash Amount                                      NAUPA 
Last Known Address:                                When Property Became                                                                                                        Originally Owed to 
                                                                                                       Type           Relationship Code Property Code Remitted                                       Deduction Code 
Street/City/State/ Zip                             Payable to Owner                                                                                                                      Owner 
           1                                   2             3                              4                     5              6                 7             8                        9                     10 
                                                                                                                                                                                                       
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