Government of the District of Columbia
                 Office of Finance and Treasury,  Unclaimed Property Department
                 1101 4th Street, SW, Suite 800W, Washington DC 20024
                 Report Of Unclaimed Property Verification And Checklist
                                                                                                                                                 FORM UP-1
Name of Business (Holder)                                                                                          Report Year (select one)
                                                                                                                   2019
Street Address                                                                                                     Tax Identification Number

City                            State                          Zip Code                                            E-mail Address

Every person, corporation, cooperative, or other business association, banking or financial organization, life insurance corporations, utility, court or public authority must complete the 
following checklist before filing their District of Columbia Unclaimed Property Report. This list includes by way of illustration, but not limitation, those items, which are covered by the 
District of Columbia Unclaimed Disposition of Unclaimed Property Act of 1980.

Please complete the checklist by indicating “Yes” or “No” by each item. Each item marked “Yes" should be  unnumbered on Unclaimed Property Form UP-2
                                      ACCOUNT BALANCES (Dormancy 3yrs)
YES  NO                                                                                YES NO
        Checking Account                                                                     Escrow Funds
        Savings Account                                                                      IRA's
        Matured Certificates of Deposit or saving certificates                               Missing Heir Funds
        Christmas Club Accounts                                                              Any other type of deposit made to a court or public authority
        Money on Deposit of secured funds                                                    Other Court Deposits
        Security Deposits 
INSURANCE (Dormancy 3 years)                                                           UTILITIES (Dormancy 1 years)
        Amounts due and payable under terms of insurance policies                            Utilities Deposits
        Claim payments                                                                       Refunds
        Drafts                                                                               Membership Fees
        Matured whole life, term or endowment insurance polices or annuity or 
        supplemental contracts
DISSOLUTION (Dormancy 60 days)                                                         PROPERTY (Dormancy 3 years)
        Any intangible personal property distributable in the course of voluntary            Contents of Safe Deposit boxes
        dissolution, which is unclaimed within 60 days after the date for final 
        distribution, is presumed abandoned
                                                                                             Contents of any other safekeeping repository
TRUST, INVESTMENT AND ESCROW ACCOUNTS (dormancy 3 years)                               OFFICIAL CHECKS (Dormancy 3 years)
        Paying agent accounts                                                                Certified Checks
        Trust Funds                                                                          Cashier Checks
        Funds held in a fiduciary capacity                                                   Registered Checks
        Funds paid toward the purchase of shares, or interest in financial or business       Bills of Exchange
        organization
        Funds received for redemption of stocks and bonds                                    Drafts
        Stocks                                                                               Warrants
        Bonds                                                                                Money Orders (Dormancy 7 years)
        Any other certificate of ownership                                                   Travelers Checks (Dormancy 15 years)
        Escrow Funds                                                                         Any other official checks
        Dividends
        Interest
        Principal payments
        Equity payments
        Profits
        Distribution
MISCELLANEOUS CHECKS AND  INTANGIBLE PERSONAL PROPERTY HELD IN THE ORDINARY COURSE OF BUSINESS (Dormancy 3 years)
        Wages (Dormancy 1 year)                                                              Royalties
        Commissions (Dormancy 1 year)                                                        Rents
        Expense Checks                                                                       Any other miscellaneous outstanding checks
        Workman’s Compensation                                                               Any checks that have been written off
        Pension Checks                                                                       Any other miscellaneous intangible personal property
        Outstanding Payroll Checks (Dormancy 1 year)                                         Accounts Payable
        Credit Checks or Memos                                                               Credit Balances-Accounts Receivable
        Payments for goods and services                                                      Discounts
        Customer Overpayments                                                                Refunds
        Unidentified Remittance                                                              Venders Checks
        Mineral Proceeds                                                                     Individual Gift 
        Membership Fees                                                                      Unredeemed Gift Certificates (Dormancy 5 years)

  List the names and last known address of all previous holders of the property if you are a successor. If you have changed 
  your name during the time in which you have held the property, list the prior name (s)
  Date of Change                 Tax Identification Number                        Name of Business (Previous Holder)

  Street Address                                                             City                                         State,      Postal Code

  Please indicate which of the following best describe the primary activity State of Incorporation                        Date of Incorporation
  of your company (select one) 

                                                                            Please explain, if No
  Did you file an unclaimed Property Report last year  Yes
  Person  to contact                                                        Telephone Number       Email-Address

                                                                  Print Form

                                                                  AFFIDAVIT

  I,                                                               , being first duly sworn on oath depose and state that I have caused to
  be prepared and have examined this report consisting of                           pages totaling $                        as to property 
  presumed abandoned under the DC Unclaimed Property Law for the year ending as stated; that I am duly authorized by the 
  holder herein to execute this report; and I believe that said report is true, correct and complete as of said date, excepting for such 
  property as has since ceased to be abandoned. Includes with this report is a cash remittance totaling $

  Sworn to (or affirmed) and Subscribed before me this

                      day of                 , 20
                                                                                         Signature of Officer, Owner, etc.

  Notary Public                                                                          Title of person signing

  My Commission expires

This report must be signed by an authorized person and acknowledged before a notary public. If a partnership, it must be signed by a partner; if an 
unincorporated association or private corporation by an officer.  
  
     Mail Reports to: Office of Finance and Treasury, Unclaimed Property Division 1101 4thStreet S.W. Suite 800 W, Washington DC 20024 
                                                                  202-442-8181 Telephone 
  
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