Comptroller of Maryland 
                                                                                                    Unclaimed Property Division 
                                                                                                    P.O. Box 17161 
                                                                                                    Baltimore, Maryland 21297-1161 
                     Maryland Unclaimed Property Report                                             410-767-1700

Holder Name:                                            Holder Number: 

For the year ended:  Detail sheet number of 
• This form should accompany Form COD/CD 918. Do not list more than ten (10) owners using this form.
• You may hand key this information electronically https://interactive.marylandtaxes.gov/business/Compliance/UnclaimedPR/

Social Security/     OWNER                                                              OFFICE USE ONLY 
FEIN Number          Name and Address    Account Number Property Type                               Owner Number   Account Amount 

COD/CD 919 0 /8 2023