Contents

AK Reporting Work Book Contents
Form 04-720A				Verification For Unclaimed Property
This form is one part of two forms that are required for paper reporting. To be used with Form 04-720B.
Form 04-720B				Report of Unclaimed Property
This form is to be used in conjunction with Form 04-720A when reporting ten or fewer properties. If you are reporting more than ten properties you must report electronically. Please visit www.unclaimedproperty.alaska.gov for free electronic reporting options.
Form SDVINV				Safety Deposit Box Inventory Listing
This form must be used when reporting Safety Deposit Box/Safekeeping items.
04-720BI
This is a guide to completing Form 04-720B. There are descriptions of each column and what should be included on your report.
Property Codes
A current listing of all acceptable property codes and dormancy periods.
Owner And Relationship Codes
A current listing of all acceptable owner codes and relationship codes. Please note these must be used when reporting electronically
Safe Deposit Box/Safekeeping Reporting Guide
Guide to reporting Safe Deposit Box/Safekeeping contents.
Form SDVINV Instructions
Instructions for completing Form SDVINV

04-720A

Department of Revenue Treasury Division PO Box 110405 Juneau, AK 99811-0405 Voice: (907) 465-3726 GOLDPAN Fax: (907) 465-2394			ALASKA DEPARTMENT OF REVENUE						DUE BEFORE NOVEMBER 1
		VERIFICATION FOR UNCLAIMED PROPERTY
			FORM 04-720A
				Federal EIN		Report Year Ending		Period Covered
Company Name (not agent or reporting service name)					Business Name
Mailing Address				City, State Zip Code
State of Incorporation		Date Incorporated			Contact Person			Contact Telephone Number
Address (if different from above)					Contact E-Mail Address			Fax Number
Holder Type:
q	Bank			q	Credit Union		q	Government, State, Local, Federal
q	Health Care Facility			q	Hospitals		q	Insurance Company - Casualty
q	Insurance Company - Life & Casualty			q	Insurance Company - Life		q	Manufacturer
q	Mutual Fund			q	Oil and Gas		q	Retail
q	Safe Deposit Company			q	Savings and Loan		q	Schools and Colleges
q	Trust Company			q	Utility		q	Other ________________________
CHANGE OF HOLDER INFORMATION (List former name, address or federal EIN)
Date of Change		Former Name			Former Address				Former Federal EIN
AGENT INFORMATION (If filed by agent, complete the following)
Agent Name				Contact Name & Phone Number			Agent Federal EIN
REMIT TO: Alaska Unclaimed Property Program						Check Enclosed			EFT or Wire Transfer
Number of Properties:	Total Amount of Unclaimed Property Reported & Remitted:			Book Entry Shares DRP Shares Mutual Fund Shares			Total Shares Remitted Depository Trust Corp:
* * * REMITTANCE AND/OR SECURTITY TRANSFERS MUST ACCOMPANY REPORT * * *
Unsworn Falsification Statement I acknowledge and affirm under penalty of perjury UNSWORN FALSIFICATION (AS 11.56.210); (i) that I have prepared, or have caused to be prepared and have examined this report; (ii) that this report is true, correct, and complete; (iii) that I have the authority to verify this report on behalf of my organization to report and transfer unclaimed property to the state; and (iv) that it is agreed that any and all transactions entered into by my organization in connection with the reporting and transfer of unclaimed property to the state, will be subject to (a) the Uniform Electronic Transactions Act (UETA) to the extent applicable under applicable state law, and (b) the federal electronic signatures in Global and National Commerce Act (E-SSIGN), with the effect that keying in our names or attaching facsimilie signatures to electronic documents indicates our intention that they be deemed to be binding electronic signatures.
Signature			Printed Name			Title			Date
FREE PROPERTY SEARCH			www.unclaimedproperty.alaska.gov				FREE REPORTING SOFTWARE
								Form 04-720A (Rev 08/2014)

04-720B

HOLDER INFO

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

Q

R

Owner Last Name (include prefix, suffix, or title)

First Name

Middle Name

Address 1

Address 2

City

State

Zip code

Property Code

Identifying Number

Interest Y/N

Owner Relationship

Owner SSN or FEIN

Last Activity Date

Number of Shares

Security Issue

CUSIP

Amount

3

4

5

6

7

8

9

10

Total Amount

This form may be saved as an Excel spreadsheet. When reporting more than 10 items the use of NAUPA electronic formatting is required. Please visit www.unclaimedproperty.alaska.gov for more information. Please provide as much information as possible. This will assist us in locating and identifying owners.

Form 04-720B (Rev 2014)

SDVINV

ALASKA DEPARTMENT OF REVENUE UNCLAIMED PROPERTY PROGRAM SAFETY DEPOSIT BOX INVENTORY LISTING FORM SDBINV
(Department of Revenue Only) Vault Location_________ Confirmed by:________
Name of Bank, Institution or Company and Branch location:____________________________________
Name of Box Owner(s):____________________________________________________________________
Box Number:____________ Date Drilled:_______________ Report Year:_________
NOTE: No safekeeping item may be sold, destroyed, or disposed of without written consent of the Dept of Revenue. Exceptions: Hazardous Materials contact Dept of Environmental Conservation or local Hazardous Waste Center. Firearms, Contact Dept of Revenue (907) 465-3726 for information on the processing of firearms for transport. All items must be included on the inventory list (no exceptions). Do not deposit CASH or COINS. Please send to the Dept of Revenue Unclaimed Property Office along with other safe deposit box items. Alaska Dept of Revenue, Unclaimed Property Office, P.O. Box 110405, Juneau, AK 99811-0405
(Forms and instructions available at www.unclaimedproperty.alaska.gov) Department Use Only
Quantity	Code	Contents (Detailed Description)						Disposition
I swear under penalties of perjury, the above information is true and that no items have been removed or destroyed.
Date of Inventory:_____________							Expenses Incurred by Holder
___________________________ ________________________________							Unpaid Rent		$
							Drilling		$
Signature of Bank Official			Name of Official				Safekeep Fee		$
___________________________ ________________________________							Other		$
							Total		$
Signature of Bank Official			Name of Official
Form SDBINV (R 08/14)

04-720Bi

Form 04-720B Instructions

When reporting 10 or more properties, electronic reporting is required. Please visit www.unclaimedproperty.alaska.gov for more information

Holder: Enter the holder’s (company) name, and address exactly as it appears on the Verification Form. You must include Federal Employer’s Identification Number.

Report year: Enter the year for which the report is being filed.

Period covered: Enter the time period covered. Derived from the original check dates, or account activity dates.

NOTE: If an owner has several accounts under $100 you may combine the accounts and report as one owner record. Items under $100 may be combined and reported in one aggregate amount (e.g. 32 vendor checks, each under $100).

IMPORTANT Items reported in the aggregate (without owner detail) may only be claimed by contacting the holder for owner and property detail. This type of holder contact can be eliminated by including all detail on all accounts. Electronic reporting should contain all detail - do not aggregate.

Items where an owner’s name is unknown, use “unknown” as the name.

Columns A to H: Owner information

A) List the owner’s last name. Include information that would aid in identification such as Jr., Sr., Miss, Mrs., etc., (The) should be omitted when it is the first word in a business name. When reporting certified or cashier's checks, identify the remitter, and payee along with their names and addresses. If your records do not contain an owner name, please enter "unknown" as the name.

B) List owner’s first name

C) List owner’s middle name or middle initial

D - H) List the complete address, city, state and zip code. If no address is available leave blank.

Column I: Enter property code from the description code list. If a code can not be found enter the property description.

Column J: Enter your identifying number for each item (e.g., check, bond, case or account number, etc.)

Column K: Indicate if account is interest bearing: Y / N

Column L: Owner Relationship is used to identify how the property is held, such as: joint, UGMA, etc. Use the following codes:

AD

ADMINISTRATOR

EX

EXECUTOR

PA

PAYEE

AF

ATTORNEY FOR

FB

FOR BENEFIT OF

PD

PAYABLE ON DEATH

AG

AGENT FOR

GR

GUARDIAN

PR

PERSONAL REPRESENTATIVE

AN

AND

HE

HEIR

PO

POWER OF ATTORNEY

AO

AND/OR

IN

INSURED

RE

REMITTER

BF

BENEFICIARY

IT

IN TRUST FOR

SO

SOLE OWNER

CC

CO-CONSERVATOR

JC

JOINT IN COMMON

TC

TENANTS IN COMMON

CF

CUSTODIAN FOR

JE

TENANTS IN ENTIRETIES

TE

TRUSTEE

CN

CONSERVATOR

JS

JOINT W/ SURVIVORSHIP

UF

USUFRUCT

CP

COMMUNITY PROPERTY

JT

JOINT TENANTS

UG

UNIFORM GIFTS TO MINOR

DF

DEFENDANT

OR

OR

UN

UNKNOWN

ES

ESTATE

OT

OTHER

UT

UNIFORM TRANSFER TO MINOR

Column M: Enter the owner’s social security number, birth date, federal employer identification number or other information that assists in identification of an owner. These numbers are essential in paying claims. If the information is available, please include in your report.

Column N: The “date of last transaction” is the last deposit, withdrawal or contact made by the owner. It is also the date property became payable, redeemable, or returnable such as the date a dividend became payable, check or draft was issued or gift certificate was purchased. If payable on demand, the date an instrument was issued should be used. If the item is a savings certificate, use the initial date of maturity when determining abandonment, notwithstanding that the instrument has an automatic rollover provision.

Column O: The number of shares for each owner or the actual or estimated value placed in parentheses to denote a non-cash item. The face value on the instrument may be used if no other value is known.

Column P: Issue name of the security

Column Q: CUSIP number must be entered for accounts assigned a CUSIP. Securities must be transferred to: State of Alaska, Department of Revenue, Unclaimed Property. Transfer instructions are under reporting forms on our website www.unclaimedproperty.alaska.gov

Column R: The total amount or value due an owner including interest or accruals earned through June 30 of the reporting year or the total number of shares for each owner.

Attention Holders: If service charges have been deducted, the holder shall include or attach, as part of the report, a copy of the contract authorizing such service charges and the date(s) on which such service charges were deducted (may attach separate sheet). This information must be reported even though the total of the service charges deducted from an item of property equals or exceeds the value of the item. In no event may service charges be deducted from an item after June 30 of the year in which it is reportable as unclaimed property.

Reports containing ten (10) or more unclaimed property items must be submitted electronically.

Instructions, Electronic Format, Statutes, and General Information are available at:

www.unclaimedproperty.alaska.gov

PROPERTY CODES

ALASKA UNCLAIMED PROPERTY CODES AND DORMANCY PERIODS
Items you may have on record, that have remained inactive, uncashed or no owner initiated activity for the following dormancy periods must be reported and turned over to the State of Alaska under AS 34.45.110-780
		ACCOUNT BALANCES	Years				COURT, STATE, MUNICIPALITY, OR OTHER GOVERNMENT, GOVERNMENT SUBDIVISION, OR AGENCY, PUBLIC CORPORATION, OR PUBLIC AUTHORITY	Years
	AC01	Checking Accounts		5		CT01	Escrow Funds - Court related		1
	AC02	Savings Accounts		5		CT02	Condemnation Awards		1
	AC03	Matured CD or Savings Certificate		5		CT03	Missing Heirs		1
	AC05	Money on Deposit to Secure Fund		3		CT04	Suspense Accounts - Court or Govt related		1
	AC06	Security Deposits		3		CT05	Other Court Deposits or Refunds		1
	AC07	Unidentified Deposits		3		CT21	Any Other Intangible Property		1
	AC21	Other Accounts		3
		UNCASHED CHECKS					INSURANCE
	CK01	Cashier's Checks		5		IN01	Individual Policy Benefits or Claim Payments		3
	CK02	Certified Checks		5		IN02	Group Policy Benefits of Claim Payments		3
	CK03	Registered Checks		5		IN03	Proceeds Due Beneficiaries		3
	CK04	Treasurer's Checks		5		IN04	Proceeds from Matured Polices, Endowments		3
	CK05	Drafts		5			or Annuities
	CK06	Warrants		5		IN05	Premium Refunds		3
	CK07	Money Orders		5		IN06	Unidentified Remittances		3
	CK77	Money Orders non-bank		7		IN07	Other Amounts Due Under Policy Terms		3
	CK08	Traveler's Checks		15		IN08	Agent Credit Balances		3
	CK09	Foreign Exchange Checks		5		IN09	Drafts Unpresented For Payment		3
	CK10	Expense Checks		3		IN10	Demutualization Proceeds		2
	CK11	Pension Checks		3		IN11	Demutualization Stock		2
	CK12	Credit Checks or Memos		3		IN21	Other Insurance Related Property		3
	CK13	Vendor Checks		3			SECURITIES
	CK14	Checks Written Off to Income		3		SC01	Dividends		5
	CK15	Other Outstanding Official Checks		5		SC02	Interest (e.g. Bond Coupons)		5
	CK16	CD Interest Checks		5		SC03	Principal Payments		3
	CK21	Other Checks		3		SC04	Equity Payments		3
		MINERAL PROCEED & INTEREST				SC05	Profits		3
	MI01	Net Revenue Interest		3		SC06	Funds Paid to Purchase Shares		3
	MI02	Royalties		3		SC07	Funds for Stocks & Bonds		3
	MI03	Overriding Royalties		3		SC08	Shares of Stock (Ret by PO)		5
	MI04	Production Payments		3		SC09	Cash for Fractional Shares		5
	MI05	Working Interest Under Aggregate		3		SC10	Unexchanged Stock of Successor Corp		5
	MI06	Bonuses		3		SC11	Other certification of Ownership		5
	MI07	Delay Rentals		3		SC12	Underlying Shares of Other Outstanding Certificates		5
	MI08	Shut-in Royalties		3		SC13	Funds for Liquidation / Redemption of Unsurrendered		3
	MI09	Minimum Royalties		3			Stocks or Bonds
	MI21	Other Mineral / Royalty Property		3		SC14	Debentures		5
		MISCELLANEOUS				SC15	Government Securities/Municipal Bonds/Interest		1
	MS01	Wages, Payroll, Salary		1		SC16	Mutual Fund Shares		5
	MS02	Commissions		3		SC17	Warrants (Rights)		3
	MS03	Worker's Compensation Benefits		3		SC18	Matured Bond Principal - (Municipal Bond use SC15)		5
	MS04	Payment for Goods & Services		3		SC19	Dividend Reinvestment Plans		5
	MS05	Customer Overpayments		3		SC20	Credit Balances		3
	MS06	Unidentified Remittances		3		SC21	Other Security Related Property		3
	MS07	Unrefunded Overcharges		3			TRUSTEE & ESCROW ACCOUNTS
	MS08	Accounts Payable		3		TR01	Paying Agent Accounts		3
	MS09	Credit Balances - Accts. Rec.		3		TR02	Undelivered or Uncashed Dividends		3
	MS10	Discounts Due		3		TR03	Funds Held in Fiduciary Capacity		3
	MS11	Refunds Due		3		TR04	Escrow Accounts		3
	MS12	Unredeemed Gift Certificates		3		TR05	Trust Vouchers		3
	MS13	Unclaimed Loan Collateral		3		TR06	Pre-Need Funeral Plan		3
	MS14	Pension & Profit Share Plans e.g. IRA/KEOGH		3		TR21	Other Trust Property		3
	MS15	Dissolution & Liquidation		1			UTILITIES
	MS16	Misc Outstanding Checks		3		UT01	Utility Deposits		1
	MS17	Misc Intangible Property		3		UT02	Membership Fees		1
	MS18	Suspense Liabilities		3		UT03	Refunds or Rebates		1
	MS21	Other Miscellaneous Checks		3		UT04	Capital Credit Distributions		1
		SAFE DEPOSIT BOXES, SAFEKEEPING				UT21	Other Utility Property		1
	SD01	Safe Deposit Box Contents		1			PROPERTIES NOT IDENTIFIED ABOVE
	SD02	Other Safekeeping		1		ZZ01	Resolution Trust Corp/FDIC Accounts		1
	SD21	Other Tangible Property		1		ZZ02	Housing and Urban Development		1
						ZZZZ	Properties Not Identified Above		3
							AGGREGATE PROPERTY
						AC99	Aggregate Property

OWNER AND RELATIONSHIP CODES

ALASKA UNCLAIMED PROPERTY OWNER AND RELATIONSHIP TYPE CODES
OWNER RELATIONSHIP
Please use an owner relationship code to clarify the relationship between multiple owners listed on a property. Indicate a relationship for each owner.
OWNER RELATIONSHIP				CODE	OWNER RELATIONSHIP				CODE
ADMINISTRATOR				AD	JOINT TENANTS IN COMMON				JC
ATTORNEY FOR				AF	TENANTS IN ENTIRETIES				JE
AGENT FOR				AG	JOINT WITH RIGHTS OF SURVIVORSHIP				JS
AND				AN	JOINT TENANTS				JT
AND/OR				AO	OR				OR
BENEFICIARY				BF	OTHER RELATIONSHIP				OT
CO-CONSERVATOR				CC	PAYEE				PA
CUSTODIAN FOR				CF	PAYABLE ON DEATH				PD
CONSERVATOR				CN	PERSONAL REPRESENTATIVE				PR
COMMUNITY PROPERTY				CP	POWER OF ATTORNEY				PO
DEFENDANT				DF	REMITTER (PURCHASER)				RE
ESTATE				ES	SOLE OWNER				SO
EXECUTOR OR EXECUTRIX				EX	TENANTS IN COMMON				TC
FOR BENEFIT OF				FB	TRUSTEE				TE
GUARDIAN				GR	USUFRUCT				UF
HEIR				HE	UNIFORM GIFTS TO MINOR				UG
INSURED				IN	UNKNOWN				UN
IN TRUST FOR				IT	UNIFORM TRANSFER TO MINOR				UT
OWNER TYPE
When reporting electronically please use the number associated with the Owner Type
OWNER TYPE								CODE
AGGREGATE								1
BUSINESS/CORPORATION								2
INDIVIDUAL								3
OTHER								5
UNKNOWN								7
Thank you for your care and prudence when preparing your unclaimed property report. This information is crucial in identifying and verifying the rightful owner is refunded.

SDB REPORTING GUIDE

ALASKA DEPARTMENT OF REVENUE UNCLAIMED PROPERTY SAFE DEPOSIT BOX CONTENTS/SAFEKEEPING ITEMS REPORTING GUIDE
All tangible and intangible property held in a safe deposit box (SDB) or any other safekeeping repository in this state in the ordinary course of the holder's business, which remain unclaimed by the owner for more than one year after the lease or rental period on the box has expired, are presumed abandoned.
AGING
Age from the rental expiration date - not the drill date. (dormancy period 1 year)
REPORTING
Report and remit before November 1st of each year
REPORTS
The report must include all information available on the account such as, owner name, box number, last known address, owner identification such as Jr./Sr./Dr. If more than one owner is listed on the account, list the names of all owners and their relationship to each other, e.g. Joint Tenants, And, Custody For, In Trust For. Attach to each report an inventory list for each safe deposit box, including empty boxes.
SPECIAL SITUATIONS
When you inventory the safe deposit box or safekeeping item you may find items that appear to be unsafe or that represent a hazardous situation. Properly dispose of the item and list the type of action used for disposal.
HAZARDOUS ITEMS MAY INCLUDE
* OLD BATTERIES					*EXPLOSIVES OR HIGHLY COMBUSTIBLE LIQUIDS
*UNLABELED LIQUIDS OR CHEMICALS					*UNSEALED HUMAN REMAINS
*ITEMS COVERED WITH APPARENT BODILY FLUID					*DRUGS OR PARAPHERNALIA
REMITTANCE
Items contained in each safe deposit box or safekeeping repository must be packaged together in a container sturdy enough to withstand transport and must be labeled exactly as listed on the unclaimed property report. Please list multiple owners on the report and on the inventoried package(s). Multiple packages for the same owner/box may be labeled 1 of 2, 2 of 2. Multiple packages are boxed together with a copy of the inventories and mailed to the State Unclaimed Property Office. NOTE: Packages damaged during shipment will be returned to the sender to be inventoried, re-packaged, and re-submitted.

SDVINV-INST

INSTRUCTIONS FOR SAFE KEEPING INVENTORY SHEET
Do not sell any items. The State will conduct an auction and reimburse costs for drilling and past due rent.
NAME OF BANK OR INSTITUTION AND BRANCH LOCATION
Enter the holders name and branch location whre the property was held.
NAME OF BOX OWNER(S)
Enter the full name(s) of the owner(s) of the safe deposit box. Be sure to include information which would assist with owner identification e.g. Jr., Sr., Mrs., and, or, Joint Tenants, etc. Social Security Number, last known address, birth date are also very important in identifying an owner, please provide if available.
BOX NUMBER
Enter the safe deposit box number or location where item was found.
DATE DRILLED
Enter the date the safe deposit box was drilled.
REPORT YEAR
The filing year of the report (based on records from July of the prior year through June 30 of current year).
CODE: PROPERTY DISCRIPTION (ABBREVIATION)
TITL	CAR TITLE - DMV				DOC	PAPER DOCUMENTS
CNS	COINS				SEC	STOCK, BEARER BONDS, ECT.
CURR	CURRENCY				SBON	US SAVINGS BONDS
JEWL	JEWLERY				FIRE	FIREARM
MIL	MILITARY PAPERS				KNIF	KNIFE
VMIS	MISC. WHICH MAY HAVE VALUE				LIFE	WHOLE/UNIVERSAL LIFE INS.
MISC	OTHER TANGIBLE PROPERTY				WILL	WILLS SIGNED ORIGINAL/COPIES
INDIVIDUAL DESCRIPTIONS OF SAFEKEEPING OR SAFE DEPOSIT BOX ITEMS
Enter the quantity and a detailed descripion of each item.
EXAMPLE
1	YELLOW COLORED RING WITH TWO CLEAR STONES
3	SILVER COLORED NECKLACES
1	COIN WRAPPER CONTAINING 50 US PENNIES
1	COIN BOOK CONTAINING 13 JEFFERSON NICKLES
1	LUCKY STRIKE MINING COMPANY CERTIFICATE #LSM634, 50 SHRS COMMON STOCK
1	ENVELOPE CONTAINING 2 WILLS, 4 BIRTH CERTIFICATES AND MISC. LEGAL PAPERS
DISPOSITION
Do not write in this area. Department use only.
REIMBURSEMENT REQUEST - DO NOT DEDUCT ANY FEES, EXPENSES, OR OTHER CHARGES FROM CASH INVENTORY. Holders may request reimbursement from the State of Alaska for expenses and fees. The State will reimburse holder after contents have been liquidated. DO NOT SELL ITEMS TO OFFSET FEES.
SIGNATURE OF BANK STAFF
Signature of staff conducting inventory.
DATE OF INVENTORY
Date the inventory was done.
ALASKA FORM SDBINV IS REQUIRED FOR ALL SAFE DEPOSIT BOXES AND SAFEKEEPING ITEMS REPORTED & REMITTED TO THE STATE OF ALASKA

---

Document checksum: 3004861523

Document converted by WebSite-Watcher.
(Plugin #1/1.38/3.0.24/1.0)