1. No category

MED P
R
ERTY
AZ
AI
OP
UNC
L
State of Arizona
Unclaimed Property
Reporting Manual
Report & Instructions
2014
651
(602) 716-6031 or (602) 716-6032  (602) 716-7997  [email protected]
STATE OF ARIZONA
Department of Revenue
Janice K. Brewer
Governor
David Raber
Director
Dear Unclaimed Property Holder:
On behalf of the citizens of Arizona, I would like to thank you for taking the
time to file your Unclaimed Property Report with the Arizona Department of
Revenue. We have made every effort to design this booklet to be
informative and as user friendly as possible. By completing your annual
report, you are not only complying with Arizona Revised Statutes, Title 44,
Chapter 3, but you are performing a valuable service to the community by
helping us protect abandoned property.
The Unclaimed Property Unit works hard to assist holders and claimants of
abandoned assets alike. Each year we collect thousands of new properties
and return millions of dollars to its rightful owners. Unclaimed Property has
become an increasingly important program for our growing population, and
you complete the first step by filing this report and remitting abandoned
assets to the Department of Revenue.
If you should have any questions about how to complete the report forms
contained in this booklet, feel free to contact the Holder Compliance Unit at
one of the numbers listed within the instructions. Electronic versions of this
booklet along with fillable forms are available from our website at
www.azunclaimed.gov.
Again, thank you for helping us return property to its rightful owner.
Sincerely,
David Raber
Director
1600 West Monroe Street, Phoenix AZ 85007-2650
www.azdor.gov
TAB
T LE OF
O CONT
C TENTTS
Ge
eneral Overrview
What is Unclaimed
U
Pro
operty? ................................ .....................................................
Who must report Unclaimed Property? ……………
…………………
……….…………
…….
What Un
nclaimed Prop
perty should be
b reported? …
…………………
………....................
1
1
1
Reportin
ng Methods an
nd Requireme
ents ……………
……………….................................
When to
o File……………
…………………
……………………
…………………
………….…….…
…...
Method of Payment…
……………………………………
…………………
…….……………
…….
Holder Due
D
Diligence…………………
…………………
……………….…
…………………..….
Sample Due Diligence
e Letter ………
………………… …………………
….………………
…..
2
2
2
2
3
Requesting Reimburse
ement …………
…………………
…………………
……………………
…..
4
Rep
porting Insttructions
General Reporting ……………………
…………………
…………………..…………………
…..
…
………………… …………..……
……………………..
Electronic Reporting …………………
5
6
C
Page …………………
…
…………………
…………………
……..……………
……
Report Cover
Schedule
e A ……………
…………………
……………………
…………………
…………...………..
7
8
Securitie
es Report
Securitie
es Remittance
e …………………………………
…………………
……………………..
Mutual Funds
F
…………
……………………………………
….………………
…………………
…….
Worthlesss or Non-Transferable Secu
urities …………
……………………………..……
…….
9
9
9
Safe De
eposit Box Re
eport
When to
o Report ………
…………………
……………………
….………………
…………………
…....
How to Report
R
…………………………
……………….…
…………………
……………………
…..
When to
o Remit Safe Deposit
D
Box Co
ontents ………
……………………..……………
…….
Packaging Contents …………………
…
…………………
…………..………
…………………….
Deliverin
ng Contents …………………
…
…………………
…………………
…….……………
…….
10
10
11
11
11
Negative
e Report ………………….……
…………………
…….……………
…………………
…….
12
Co
odes, Tabless and Chec
cklist
NAUPA Property
P
Type Codes ………
………………… …………………
………..…………..
Relationship Codes/Payment Proto
ocols ………… …………………
…………………
……
Quick Re
eference Guid
de ………………………………
…………………
…………………….
Remit Ye
ear Tables ……
…………………
……………………
…………..………………………
…...
Unclaimed Property Terms …………
……………………
…………………
…………………
…….
Checklist ………………
……………………………………
…………………
……………………..
Forms …………
…………………
…………………
……………………
…………………
……
13-14
15
16
17
18
19
20
www.azu
unclaim
med.go
ov
A
Arizona Unclaim
med Property Re
eporting Manua
al
GEN
G ERA
AL OV
VER
RVIEW
W
Wh
hat is Unc
claimed Property?
??
Unc
claimed Prope
erty is a financ
cial asset owe
ed to an indiviidual or busine
ess. Property iis considered unclaimed w
when there
has been no own
ner contact fo
or a specified period of time, usually bettween 1 and 3 years.
en efforts by the
t
holder to locate
l
the ow
wner fail, the funds must be
e turned over to the Departtment of Reve
enue which is
Whe
then
n responsible for safeguard
ding the fundss, attempting to locate the
e owners, publicizing the na
ames of appa
arent owners
and
d returning the
e assets to the
e owners as th
hey come forw
ward.
ona Unclaimed Property Ac
ct is located in
n Arizona Rev
vised Statutes, Title 44, Chap
pter 3, and ca
an be found
The Revised Arizo
online at www.azzleg.gov .
Wh
ho must report
r
Un
nclaimed Property
y?
Any
y person or en
ntity in possesssion of property (subject to
o the Act) wh
hich belongs tto another, orr who is truste
ee in case of
a tru
ust, or who is indebted to another perso
on on an obligation subjec
ct to the Act,, is deemed a holder of unc
claimed
prop
perty and mu
ust report that property to th
he state. All holders,
h
whetther located in Arizona orr in other states, must
repo
ort to the De
epartment of Revenue any
y unclaimed property
p
theyy hold that is o
owed to Arizona residents. Arizona
dom
miciled busine
esses must also
o report all pro
operty where the owners n
name and ad
ddress is unknown. All busiiness entities
are responsible fo
or filing reports on behalf of
o their branch
hes, divisions o
or other affilia
ates, including
g:

Banking and financiall institutions in
ncluding state or federally c
chartered ban
nks, trust com
mpanies, savings banks,
private bankers,
b
savings and loan associations,
a
credit
c
unions a
and investment companies.

Business associations wherever located, such ass a corporatio
on, joint stock company, bu
usiness trust, p
partnership,
proprieto
orship, cooperative, or othe
er association for business p
purposes (incl uding all insurrance compa
anies).

Other leg
gal entities inc
cluding state, county and city
c governme
ents, political subdivisions, public authorrities, public
corporattions, estates, trusts or any other
o
legal or commercial e
entity.
Info
ormation abou
ut other states and their un
nclaimed property reportin
ng requirements can be accessed throu
ugh the
NAU
UPA (Nationall Association of
o Unclaimed Property Adm
ministrators) w
web site at ww
ww.unclaimed
d.org
Wh
hat Uncla
aimed Pro
operty sh
hould be reported
d?
Rep
portable itemss with respective property codes
c
and do
ormancy perio
ods are locate
ed in the NAU
UPA property ttype
cod
des section of this booklet. Holders must report all unc
claimed prope
erty that is ow
wed to an Arizona resident o
or
busiiness. In addittion, Arizona domiciled
d
hold
ders should report items to Arizona witho
out an owner name or address and
all u
unclaimed pro
operty where the last know
wn address is in
n a foreign co
ountry.

Securities representing
g underlying shares,
s
stock splits,
s
bonds, e
etc., must be registered in A
Arizona’s nom
minee name
of CACTUS & CO. (See
e the instructio
ons for Reportting Securities section for m
more informatio
on).

Safe Dep
posit Box conttents that hav
ve been uncla
aimed by the owner for a p
period of three
e years after e
expiration of
the lease
e must be reported. Please
e complete an Unclaimed Property repo
ort (650C), ind
dicating on the
e Schedule
A all ava
ailable informa
ation, and contact safekee
eping represe
entative at (60
02) 716-6035 to
o arrange for delivery of
the prop
perty.
1
A
Arizona Unclaim
med Property Re
eporting Manua
al
GEN
G ERA
AL OV
VER
RVIEW
W
Re
eporting Methods
M
and Requirementts
Hold
ders should re
eport via CD/D
DVD or USB fla
ash drive, follo
owing the NAU
UPA format sp
pecifications, a
and also prov
vide a hard
cop
py signed repo
ort covershee
et. Reports nott received according to the
e prescribed format will be
e returned for correction.
For assistance with reporting, contact
c
the Ho
older Complia
ance Section at (602) 716-6
6031 or (602) 716-6032. Yo
ou can also
mail us at Repo
ortingUnclaim
medProperty@a
azdor.gov.
e-m
Wh
hen to File
In A
Arizona, a life insurance com
mpany that is a holder of property
p
that iis presumed a
abandoned sh
hall file its report before
May
y 1, and the report
r
shall co
over the prior calendar yea
ar. Any other h
holder of prop
perty that is p
presumed aba
andoned
shalll file the repo
ort before Nov
vember 1, and
d the report shall
s
cover the
e last twelve months beforre July 1 of that year. A
hold
der may also make a one
e-time electio
on to annually report the property at tthe same tim
me it reports itss income for
the purposes of in
ncome tax pu
ursuant to Title
e 43.
ension inquiriess for filing a Re
eport of Uncla
aimed Properrty be submittted to the Holder
The Department requests exte
Com
mpliance Unitt in writing prio
or to either Ap
pril 1 or Octob
ber 1 (whichev
ver applies). Please includ
de the entity's FEIN and
leng
gth of time ne
eeded within the
t
request.
Me
ethod of Paymentt
All c
checks must be made pa
ayable to “Ariizona Departm
ment of Reve
enue, Unclaim
med Property Unit” for the total
amo
ount listed on
n the Report of Unclaime
ed Property. Your
Y
remittan
nce must be in U.S. curre
ency. Foreign currency
can
nnot be accep
pted.

Do not make
m
checks payable
p
to th
he original owner or include
e the original o
owner’s name
e in the payee section of
the chec
ck.

Do not se
end the origin
nal instrument that was issue
ed to the own
ner. This office
e can only de
eposit checks made
payable to the Arizona Unclaimed Property Unit.

Do not su
ubmit an indiv
vidual check for
f each prop
perty being re
eported.

Alert the Unit at ReporrtingUnclaime
edProperty@a
azdor.gov if ch
heck or reportt is being mailed under sep
parate cover
heck will be re
eturned unpro
ocessed.
or the ch
Ho
older Due
e Diligenc
ce
The Act requires that
t
prior to one
o
hundred twenty
t
days before
b
the hol der of properrty that is pressumed aband
doned files
theiir report, the holder
h
shall send a written notice
n
to the apparent
a
own
ner that state
es that the holder is in posse
ession of the
prop
perty if all of the
t
following apply:
a

The holder has an add
dress in the ho
older's recordss for the appa
arent owner a
and the record
ds do not indicate that
the addrress is inaccurrate.

The claim
m of the appa
arent owner is not barred by
b any other la
aw of this state
e.

The value
e of an individ
dual property is at least fifty
y dollars.
2
A
Arizona Unclaim
med Property Re
eporting Manua
al
GEN
G ERA
AL OV
VER
RVIEW
W
Sample Due Dilige
ence Lette
er
ame
Owner Na
123 Main Street
S
City Name
e, State, Zip
Re:
(Pro
operty Description or Ac
ccount No.)
Our records indicate that
t
we are holding unc
claimed prop
perty in the a
amount of $
due
e
bove. The ow
wner may cla
aim this prop
perty by con
ntacting us a
at the addre
ess
to the perrson listed ab
and/or ph
hone numbe
er listed below.
ormation:
Holder Info
Co
ompany Nam
me
Ad
ddress
Phone Number
n hear from
m the owner before (inse
ert the last day that the company can remove iitems
If we do not
for refund
d reporting and
a
remitting
g to the State), Arizona llaw requires us to submiit this properrty to
the Arizon
na Departme
ent of Reven
nue, Unclaim
med Property
y Unit before
e November 1.
Sincerely,
ny’s Contact Name)
(Compan
Street Add
dress (Includ
de Number)
City, State
e, Zip Code
PLEASE
P
SIGN BELOW TO ACKNOWLED
A
GE OWNERSHIP OF THE A
ABOVE LISTED
D FUNDS
Printed Owner Nam
me
Owner Siignature
Action to be taken (PLEASE CHEC
CK ONE)
 Reissue Check
 Update A
C
(origin
nal is/is not enclosed)
e
Account (pa
assbook is/is n
not enclosed
d)
 Close Ac
ccount and Send Check
k (passbook is/is not enclosed)
 Other (explain)
____________
_____________
____________
____________________________________________________
_________
_________
____________
_____________
____________
____________________________________________________
_________
____________
_____________
____________
____________________________________________________
3
A
Arizona Unclaim
med Property Re
eporting Manua
al
GEN
G ERA
AL OV
VER
RVIEW
W
Req
questing Reimburssement
Afterr a report is submitted, a ho
older may cho
oose to repay the owner di rectly or may
y determine th
hat items withiin the
reporrt were filed in
n error. In thesse cases, the holder
h
may se
eek reimburse
ement by subm
mitting the Ho
older Request for
Reimbursement fo
orm (Arizona Form 670) alon
ng with the req
quired docum
mentation sub
bstantiating th
he repaymentt or error.
Pleasse use the currrent version, 670
6 revised 09
9/09. All othe
er forms are ob
bsolete and w
will not be acc
cepted.
Section 1
In this section, identiffy your compan
ny and designa
ated
act.
conta
Reporrt Year - the yea
ar in which the requested prop
perty
was re
eported to the State of Arizona
a.
Reporrt Amount – the
e total dollar am
mount of the rep
port you
are re
eferencing.
Prope
erty Type Code – the property type code used
d to
identify the property
y you are requesting.
egate – indicate
e if the property
y you are reque
esting
Aggre
was re
eported in aggregate form.
Prope
erty Amount - the
t
amount of funds,
f
shares, or
o
tangib
ble properties transmitted to th
he State, for the
e
prope
erty in question..
Owne
er Name and Ad
ddress - the full name and add
dress of
the ow
wner as it is sho
own on the repo
ort.
Prope
erty Description – the descriptio
on of the prope
erty you
are re
equesting, such as, the identific
cation, check, or other
refere
ence number.
Section 2
In this section, identiffy property for which
w
the holde
er is
ng reimburseme
ent.
seekin
Holde
er Name – the name
n
of your company as liste
ed on
the Un
nclaimed Property Report you
u are referencin
ng.
Tax Id
dentification Nu
umber – the taxx id number rep
ported
on the
e Unclaimed Prroperty Report you are referen
ncing.
Mailin
ng Address – the mailing addrress of your com
mpany
as de
eclared on yourr most recent Unclaimed Property
report (Arizona Form
m 650A-C).
act Person / Co
ontact Informatiion – the name
e of
Conta
your c
company’s dessignated State contact as
designated on the most
m
recent rep
port filed (Arizon
na
Form 650A-C).
Section 3
In this section, carefu
ully read the ho
older declaratio
ons
ndemnity agree
ement.
and in
Section 4
In this section, a nota
arized signature
e of the designa
ated
act person is req
quired.
conta
Plea
ase Note:
1.
2.
All fields in each
e
section of the form must
m
be complleted before tthe State of Arrizona will pro
ocess your req
quest for
information or make pay
yment.
You are req
quired to subm
mit documenta
ation to suppo
ort your claim
m for reimburse
ement, which may consist o
of copy
of cancelled check(s), front, and back, evidence of
o account rea
activation, orr a sufficient le
etter of explan
nation.
e
de
esignated as the Unclaimed
d Property co
ontact on the llast report (Arrizona Form 650A-C) may
Only a company employee
reque
est a holder re
eimbursemen
nt. An officer of your comp
pany may cha
ange the dessignated conttact person/ c
contact
inform
mation by completing Arizo
ona Form 285
5UP and Arizona Form 650A
A(Sections 1 a
and 2). The de
esignated co
ontact will be
respo
onsible for all ongoing interraction with th
he Arizona Un
nclaimed Prop
perty Section .
4
A
Arizona Unclaim
med Property Re
eporting Manua
al
REP
R ORTTING
G INS
STRU
UCTIIONS
S
General Reportin
ng
We a
ask that you adhere to the procedures and
a
forms inclu
uded in this b
booklet.
If you
u have any qu
uestions, please call (602) 716-6031
7
or (60
02) 716-6032.
Plea
ase Note

There is a different report cover page for eac
ch type of pro perty you are
e reporting:

65
50A - Cash on
nly

65
50B - Securitie
es and Cash

65
50C - Safe De
eposit Box Con
ntents only
Reporrt Cover Page 650
0A
Report Co
over Page 650 B
Report Cove
er Page 650 C

It is im
mportant that you
y
familiarize
e yourself with
h the instructio
ons for reporti ng securities b
before you tra
ansfer or reregiste
er any stock/m
mutual fund.

It is im
mportant that you
y
review the payment protocol for ea
ach relationsh
hip type that y
you report. Yo
ou are
responsible for cho
oosing the cod
de that correc
ctly reflects th
he named perrson’s relation
nship to the prroperty.

Includ
de all known owner
o
identifie
ers for each property
p



So
ocial security or Tax Id num
mbers
Dates of Birth
olicy, accoun
nt or check nu
umbers
Po
The
e more info
ormation the
t
State re
eceives wiith your report the le
ess likely
they are
e to contact you eac
ch time a c
claim is file
ed or to re
efer
claimants to
o your esc
cheatmentt specialistt for additio
onal inform
mation.
5
A
Arizona Unclaim
med Property Re
eporting Manua
al
REP
R ORTTING
G INS
STRU
UCTIIONS
S
Ele
ectronic Reporting
R
g
We recommend that you upda
ate your softw
ware yearly ass the standard
d reporting forrmat does cha
ange.
It is required that data be sentt according to
o these speciffications:




Use a CD, DVD or USB fllash drive.
Clearly lab
bel the outside of the disk with
w the holde
er name, hold
der address, n ames of each
h file containe
ed on the
disk and the format use
ed (e.g., Wagers, HRS, or NA
AUPA).
When reporting multiple
e companies on one CD, DVD
D
or USB fla
ash drive assig
gn each comp
pany a
f name.
separate file
Type all re
ecords in UPPE
ER CASE style.
Magnetic tape or cartriidge media iss not accepta
able.
d passwords and/or instructtions for retriev
ving data which is passworrd protected o
or in special e
encryption sofftware to
Send
Repo
ortingUnclaime
edProperty@a
azdor.gov or provide
p
a con
ntact person a
and telephone
e number with
h your report a
and
remitttance.


CD ROM
MS and USB flash drives in NA
AUPA format that
t
contain tthe “HDE” file extension are
e encrypted a
and do not
require password
p
prottection.
CD ROM
MS and USB flash drives in NA
AUPA format that
t
contain tthe “HRS” file extension are
e not encrypte
ed and
should be sent under protected me
eans.
Passw
words for non--encrypted files need to be
e e-mailed pro
omptly to rep
portingunclaim
medproperty@
@azdor.gov. The subject
line o
of the e-mail must
m
identify the report(s) protected
p
by the
t
password .
Apprroved reportin
ng software is available, fre
ee of charge at:
a
Holders may complete
c
reports on-line wiith this free ap
pproved softw
ware at
ETM-H
http:///www.byetm
m.com/index.p
php/upx
For cu
ustomer servic
ce, please co
ontact ETM at (319) 739-355
57 or by email at support@b
byetm.com
Arizon
na does not provide
p
techn
nical support o
of HRS Pro, ho
owever, holde
ers may contin
nue to
down
nload this free
e software and
d User’s manu
ual from Xeroxx Reporting Sy
ystem (HRS) so
oftware
pack
kage to submit unclaimed property
p
on a CD ROM or U
USB drive in NA
AUPA format at
www
w.wagers.net From
F
the main
n page, click o
on the Free Holder Softwarre icon and fo
ollow the
instruction to down
nload. For que
estions or add
ditional inform
mation, please
e contact Xero
ox Wagers at
(303) 413-9450.
Arizzona will no
o longer accept
a
Rep
ports in Exc
cel Formatt
6
A
Arizona Unclaim
med Property Re
eporting Manua
al
REP
R ORTTING
G INS
STRU
UCTIIONS
S
Re
eport Cov
ver Page
This fform must be
e submitted in hard copy
y.
Sec
ction 1
In th
his section, ide
entify your company
and
d designated contact. The
designated conttact will be
resp
ponsible for alll ongoing
inte
eraction with the
t
Arizona
Unc
claimed Prope
erty Section. Future
corrrespondence and holder
reim
mbursements will
w be sent to the
add
dress reported
d at this time.
An o
officer of your company may
m
cha
ange the desig
gnated conta
act
persson/contact information
i
by
b
com
mpleting Arizo
ona Form 285U
UP and
Arizo
ona Form 650
0A(Sections 1 and 2).
Sec
ction 2
In th
his section, ide
entify your
com
mpany’s custo
omer contact.
Unc
claimed Prope
erty clients will often
hav
ve questions th
hat can only be
b
answ
wered by an employee of your
com
mpany who is not only famiiliar with
your escheatmen
nt policy, but also
cedures and
your internal proc
ctices.
prac
Sec
ction 3
In th
his section, sum
mmarize and classify
the property you are reporting
g.
Sec
ction 4
In th
his section, ca
arefully read th
he
hold
der declaratio
ons and indem
mnity
agre
eement.
Sec
ction 5
In th
his section, the
e signature off the
emp
ployee authorized to execu
ute the
repo
ort is required.
7
A
Arizona Unclaim
med Property Re
eporting Manua
al
REP
R ORTTING
G INS
STRU
UCTIIONS
S
Sch
hedule A
The D
Department re
ecommends that you subm
mit your report in electronic format. For a
assistance in d
downloading or using free
reporrting software
e, please conttact our Holde
er Compliance Specialists a
at (602)716-60
031 or (602)716-6032.
Ite
em no:
Enume
erate each item you
y
are reporting..
Ac
ccount Number:
Provide an account number for the indiv
vidual
property being reported
d.
heck no:
Ch
Indicate a check numb
ber for the properrty being
reporte
ed.
Prroperty type: (Mandatory field) Indicate the NAUPA pro
operty code (see enclosed list)
for the
e category that be
est describes wha
at type of
property you are remitting.
Ca
ash amount remittted:
Indicate the dollar amo
ount due owner(s).
Intterest rate:
If the a
account is currenttly earning interesst, list the rate.
Last activity date:
Indicate either the chec
ck issue date, the
e date of the
last ow
wner-directed acc
count activity, the
e date the
property became paya
able or distributab
ble, or the
date o
of last contact be
etween the comp
pany and the
ownerr, whichever applies.
Ow
wner’s name and mailing address: DO NOT LIST JOIN
NT OWNERS ON TH
HE SAME LINE.
Please
e furnish the entire
e name, if known, including any title, such as Jr., Sr., or III. Corporate titles, names of trrusts, estates, parttnerships, associations, and trade
namess should be listed exactly as adoptted. If the name is unknown or no longer available,, indicate that in tthis field. Please ffurnish a complette address
includiing zip code. If th
he complete add
dress is not availab
ble, indicate the portion
p
of the add
dress that is know
wn. The last known
n address should be reported even
if it is d
determined that mail
m is no longer deliverable
d
to the owner at the add
dress.
Ow
wner’s tax ID:
Indicate the owner’s so
ocial security number or the
entity’s tax identification number.
Owner’s date
e of birth:
Indicate the own
ner’s date of birth
h (if known).
Relationship
p code: (Mandato
ory field)
Please refer to tthe relationship c
codes/ payment
protocols on the following page
e.
Fees/Drilling Costs:
If you a
are reporting the contents of a saffe deposit
box, please list all fees that
t
are due befo
ore the box
may b
be released to the
e reported owner..
hares remitted:
Number of sh
Indicate the actu
ual number of sha
ares being
remitted for each individual owne
er.
utual Fund name::
Security/Mu
Indicate the na
ame of the securitty, bond, or
mutual fund if y
you are reporting them.
CU
USIP no:
If you a
are reporting a se
ecurity, indicate the CUSIP
numbe
er. If you are repo
orting a bond, ind
dicate the
CUSIP, bond number, and any coupon numbers.
n
e of death:
Owner’s date
Indicate the own
ner’s date of dea th (if known).
Joint Owne
er’s information
Enter additiona
al owner’s informa
ation, please
follow procedures on step 8.
It is im
mperative tha
at ALL pertinen
nt property fie
elds described
d above are t horoughly co
ompleted. Thiss will aid in the
e location
and iidentification of the correc
ct owner.
8
A
Arizona Unclaim
med Property Re
eporting Manua
al
REP
R ORTTING
G INS
STRU
UCTIIONS
S
Securities Report
R
Any sstock or otherr equity interest in a businesss association or financial o
organization iss presumed abandoned if tthe property
rema
ains unclaimed
d by the owne
er for more th
han three years after the da
ate of the mo
ost recent divid
dend, stock sp
plit or other
distrib
bution.
R
ce
Securities Remittanc
Com
mplete the Re
eport of Abandoned Securities 650B. All information m
must be typed
d or printed cllearly in ink.
ck must be registered in Arizona’s nomin
nee name of CACTUS
C
& CO
O.
Stoc
ders who partticipate in DTC
C (Depository Trust Company) must transsfer re-registerred securities directly to: DTTC
Hold
Partticipant #0954
4; Account #A
AUZF0168702; Agent Bank 26017;
2
Tax ID #
#75-3121666.
Forw
ward, via fax to
t Vilka Marko
ovich (617) 72
22-9660, notific
cation of secu
urities being trransferred at lleast 24 to 48 hours prior
to th
he transfer. Include in this notification
n
the
e following: Isssue Name; CU
USIP #, numbe
er of shares and depository
y number.
If prrior notification is not receiv
ved by Ms. Ma
arkovich, the transfer will b e rejected an
nd returned to
o the holder.
o the DTC con
nfirmation alo
ong with the Unclaimed
U
Pro
operty Report you submit to
o the Unclaim
med
Include a copy of
perty Unit of th
he Arizona De
epartment of Revenue.
Prop
w not be acc
cepted in boo
ok entry form. Convert eac
ch owners account to who
ole shares,
Dividend Reinvesstment Plans will
d register the whole
w
shares into
i
our nomin
nee name. Th
he report musst indicate, for each individ
dual owner, th
he number of
and
who
ole shares and
d the amount of cash in lieu
u of fractional shares that a
are due.
Mu
utual Funds
Plea
ase transfer th
he abandone
ed shares to an account reg
gistered to the
e State of Arizzona, Unclaim
med Property Unit, Tax ID
86-6
6004791.
atements to:
Send all sta
Arizona Dep
partment of Revenue
R
Uncla
aimed Properrty Unit
Attn: Arizon
na Unclaimed Property Adm
ministrator
1600 W. Mo
onroe Street Division
D
Code 10
Phoenix, AZZ 85007
A co
opy of the fun
nds statementt must be included with the
e report for ea
ach fund repo
orted. Mutual fund stateme
ents must be
sentt to the addre
ess listed abov
ve.
It is incumbent up
pon holders to
o contact the
e individual mu
utual fund co
ompanies to in
nform them th
hat as part of the annual
ocess, they inttend to transfe
er shares into an account ffor the State o
of Arizona.
escheatment pro
ou need help,, call (602) 716
6-6031 or (602
2) 716-6032.
If yo
Wo
orthless or
o Non-Tra
ansferab
ble Securiities
Do n
not report worrthless or non--transferable securities to our
o office. If th
hese do beco
ome transfera
able or gain va
alue, report
and
d remit the sha
ares at that tim
me. You will not
n be penalizzed for late re
eporting in the
ese situations.
If yo
ou are reportin
ng securities from a safe de
eposit box, ple
ease use the IInstructions fo
or Reporting Sa
afe Deposit Bo
ox Contents.
9
A
Arizona Unclaim
med Property Re
eporting Manua
al
REP
R ORTTING
G INS
STRU
UCTIIONS
S
Safe
e Deposiit Box Rep
port
Tangible property that is held in
n a safe depossit box is presu
umed abando
oned if the prroperty remains unclaimed
d by the
owne
er for more tha
an three yearrs after the exxpiration of the
e lease or ren tal period on the box.
When to Rep
port
Safe deposit box contents
c
mustt be reported annually befo
ore Novembe
er 1st. Use form
m Arizona 650
0C to report sa
afe deposit
box c
contents only. Submit the owner
o
namess and addresses electronica
ally using the NAUPA appro
oved format.
How
w to Repo
ort
The fo
ollowing information should
d be included
d with each re
eport:
et 650 C
Report Cover Shee
onic Report (O
Owners inform
mation, TAX ID, Box numberr, past due ren
nt and/or drilliing fees, etc)
Electro
A legib
ble and reada
able copy of each invento
ory sheet for e
each box repo
orted
Repo
ort Cover Page 65
50 A
Elec
ctronic Report
Sample of Inventory Sheet
Safe Depo
osit Box Rep
ports needs to be file se
eparately frrom your cash and se
ecurities rep
ports.
Plea
ase note:






DO NOT re
eport empty boxes.
b
Report ea
ach box only ONCE.
O
Keep a co
opy of your re
eport and inve
entories for yo
our records.
Regarding
g UNKNOWN owners:
o
it is im
mportant to look at the con
ntents, as they
y may help yo
ou identify the
e actual
owner. Ple
ease note tha
at the unknow
wns are still rep
portable if the re is no identi fication made
e.
You should
d contact you
ur local law enforcement agency
a
for co
onfiscation of all controlled substances fo
ound in any
safe keep
ping receptac
cle. Make a no
ote on your inventory sheetts explaining tthat the itemss were found, but turned
over to a law enforcem
ment agency.
Report fee
es or drilling costs owed on your electron
nic report.
10
A
Arizona Unclaim
med Property Re
eporting Manua
al

REPO
R ORTTING INS
STRU
UCTIIONS
S
When to Rem
mit Safe Deposit
D
Box
B Conttents
DO N
NOT send safe deposit box contents with your report. After
A
you rem it your report,, the Unclaime
ed Property V
Vault
Supe
ervisor will contact you with a report confirmation num
mber and rem ittance instruc
ctions.
Pac
ckaging Contents
C
s




The conte
ents of each sa
afe deposit bo
ox must be pla
aced into a c
container, bag
g, or envelope
e that is prope
erly sealed
to preventt access to the contents. Th
he Departmen
nt will acceptt most forms o
of tamper proof seals includ
ding
security ta
ape and heatt sealed pack
kages. The co
ontents must b
be delivered in
n a container that is separa
ate from
the sealed
d container, bag,
b
or envelo
ope holding th
he items. Be e
especially care
eful with fragiile, heavy, or iirregular
shaped objects as item
ms are tossed around
a
during
g shipping and
d the envelop
pes they are ssent in can be
e ripped or
torn.
Each container of conttents should be
b clearly labe
eled with the owners name
e and the boxx number. If yo
ou need
more than
n one envelop
pe for each owner,
o
please indicate 1 of 2, 2 of 2, etc..
Prepare 2 copies of the
e inventory forr each owner. Place the orriginal inside w
with the conte
ents and attac
ch the
copy to th
he outside of each
e
contain
ner of contentts. Each inven
ntory sheet sho
ould include y
your company name,
owner nam
me, box number and desc
cription of eac
ch item of pro
operty.
Place env
velopes in a sh
hipping conta
ainer, alphabe
etically by ow
wner name. La
abel the outsid
de of the shipping
containerr Box __ of __ (Box 1 of 3 Ow
wners A-F, Boxx 2 of 3 Owne
ers G-R, Box 3 o
of 3 Owners S-Z).
Dellivering Contents
C
The D
Department re
ecommends that
t
contents are delivered
d in person byy an employe e of the bankk, but will accept courier
delivery if indemnified by the ho
older. These arrangements
a
s must be mad
de with the A
Arizona Unclaim
med Property
y Vault
ervisor who ca
an be reached
d at (602) 716-6035.
Supe
u choose to se
end by courie
er, use an insurred carrier in order
o
to safeg
guard and tra
ack packagess. A copy of th
he report
If you
you ssubmitted in November,
N
inc
cluding Sched
dule A, must accompany
a
th
he contents o
of the boxes y
you are remitting. The
Depa
artment will ve
erify that each
h set of conte
ents received at delivery co
orresponds to a name on the Schedule A
A. The
Depa
artment shall notify
n
you of any
a discrepan
ncies with the report.
Send
d contents to:
Arizona Departme
ent of Revenue
aimed Properrty Unit
Uncla
Vaultt Supervisor
1600 W Monroe Division Code 10
Phoe
enix, AZ 85007
11
A
Arizona Unclaim
med Property Re
eporting Manua
al
REP
R ORTTING
G INS
STRU
UCTIIONS
S
Neg
gative Re
eport
The N
Negative Repo
ort of Unclaim
med Property applies
a
to enttities that hav e no unclaimed property tto report for th
he required
perio
od. Should you have any questions,
q
contact the Repo
orting Speciallists at (602) 71
16-6031 or (60
02) 716-6032.
NOT file Negattive reports on
n CD, DVD or USB
U flash drive
e.
DO N
Sec
ction 1
In th
his section, ide
entify your com
mpany, the
repo
orting period and
a
designatted
contact. The designated conttact will be
resp
ponsible for all ongoing inte
eraction
with
h the Arizona Unclaimed Prroperty
ce and
Section. Future corresponden
c
hold
der reimbursem
ments will be sent to the
add
dress reported
d at this time. An officer
of your company
y may change
e the
desiignated contact person/contact
information by co
ompleting Arizzona Form
285U
UP and Arizon
na Form 650A(Sections 1
and
d 2).
Sec
ction 2
In th
his section, ca
arefully read th
he holder
dec
clarations and
d indemnity ag
greement.
t
employee
e authorized
The signature of the
to e
execute the re
eport is require
ed.
Negativ
ve Report Form 65
50D
12
A
Arizona Unclaim
med Property Re
eporting Manua
al
CODE
C ES, TABL
T LES A
AND C
CHEC
CKLIST
NAUPA Prop
perty Type Codes
Dorm
mancy Periods (in years) are listed in parenthesis.
ACCOUNTT BALANCES DUE
AC01
(3)
CHECKING ACCOUNTS
A
AC05
((3)
MONIE
ES LEFT ON DEPOSIT
AC02
(3)
SAVINGS AC
CCOUNTS
AC06
((3)
SECURITY DEPOSITS
AC03
(3)
CERTIFICATES
S OF DEPOSIT
AC07
((3)
UNIDEN
NTIFIED DEPOSSITS
AC04
(3)
CHRISTMAS CLUB
C
ACCOUNTS
AC08
((3)
SUSPEN
NSE ACCOUNTS
UNCAS
SHED CHECK
KS
CK0
01
(3)
CASHIERS CHECKS
CK10
((3)
EXPENSSE CHECKS
CK0
02
(3)
CERTIFIED CHECKS
CK11
((3)
PENSIO
ON CHECKS
CK0
03
(3)
REGISTERED CHECKS
CK12
((3)
CREDITT CHECKS OR MEMOS
CK0
04
(3)
TREASURERS CHECKS
CK13
((3)
VENDO
OR CHECKS
CK0
05
(3)
DRAFTS
CK14
((3)
CHECK
KS WRITTEN OFFF TO INCOME
E
CK0
06
(3)
WARRANTS
CK15
((3)
OTHER OUTSTANDING OFFICIAL C
CHECKS
CK0
07
(3)
MONEY ORD
DERS
CK16
((3)
CD INTTEREST CHECK
KS
CK0
08
(15)
TRAVELERS CHECKS
C
CK51
((3)
RONIC TRANSFFER WITHOUT A WRITTEN
ELECTR
INSTRUMENT
CK0
09
(3)
FOREIGN EXCHANGES
COUR
RT DEPOSITS
CT0
01
(2)
ESCROW FUN
NDS
CT06
((2)
VICTIM
MS RESTITUTION
N
CT0
02
(2)
CONDEMNA
ATION AWARD
DS
CT07
((3)
CHILD SUPPORT PAY
YMENTS
CT0
03
(2)
MISSING HEIR
RS FUNDS
CT08
((2)
COURTT FEES
CT0
04
(2)
SUSPENSE AC
CCOUNTS
CT09
((1)
CLASS ACTION SETTLLEMENT PROC
CEEDS
CT0
05
(2)
OTHER COUR
RT DEPOSITS
INS
SURANCE
IN01
(3)
IN02
2
(3)
INDIVIDUAL POLICY
P
BENEFFITS OR CLAIM
M
PAYMENTS
GROUP POLICY BENEFITS
IN07
((3)
IN08
((3)
UE UNDER POLICY
OTHER AMOUNTS DU
TERMS
AGENTT CREDIT BALA
ANCES
IN03
(1)
PROCEEDS DUE
D BENEFICIA
ARIES
IN09
((3)
DRAFTSS UNPRESENTE
ED
IN04
4
(3)
MATURED PO
OLICY PROCEE
EDS
IN10
((3)
IN05
(3)
PREMIUM REFFUNDS
IN12
((1)
DEMUTTUALIZATION
Y/ANNUITY PA
AYABLE ON PR
ROOF OF
POLICY
DEATH
IN06
(3)
UNIDENTIFIED
D REMITTANCE
ES
MINERA
AL PROCEED
DS
MI0
01
(3)
NET REVENUE
E INTERESTS
MI06
((3)
BONUSSES
MI0
02
(3)
ROYALTIES/PROCEEDS
MI07
((3)
DELAY RENTALS
MI0
03
(3)
OVERRIDING
G ROYALTIES
MI08
((3)
SHUT-IN
N ROYALTIES
MI0
04
(3)
PRODUCTION
N PAYMENTS
MI09
((3)
MINIM UM ROYALTIESS
MI0
05
(3)
WORKING IN
NTERESTS
13
A
Arizona Unclaim
med Property Re
eporting Manua
al
CODE
C ES, TABL
T LES A
AND C
CHEC
CKLIST
MISC
CELLANEOUS INTANGIBLEE PROPERTY
MS0
01
(1)
WAGES
MS09
((3)
A/R CR
REDIT BALANC
CES
MS0
02
(1)
COMMISSION
NS
MS10
((3)
DISCO
OUNTS DUE
MS0
03
(3)
WORKERS CO
OMP. BENEFITS
S
MS11
((3)
REFUND
DS DUE
MS0
04
(3)
GOODS OR SERVICES
S
PAY
YMENT
MS13
((3)
UNCLA
AIMED LOAN C
COLLATERAL
MS0
05
(3)
CUSTOMER OVERPAYMEN
O
NTS
MS15
((1)
DISSOLLUTION OR LIQ
QUIDATION PR
ROPERTY
MS0
06
(3)
UNIDENTIFIED
D REMITTANCE
ES
MS16
((3)
MISC O
OUTSTANDING
G CHECKS
MS0
07
(3)
UNREFUNDED
D OVERCHARG
GES
MS17
((3)
MISC IN
NTANGIBLE PR
ROPERTY
MS0
08
(3)
ACCOUNTS PAYABLE
P
MS18
((3)
SUSPEN
NSE LIABILITIES
SECURITIES
SC0
01
(3)
DIVIDENDS
SC11
((3)
SC0
02
(3)
INTEREST (BOND COUPONS
S)
SC13
((3)
OTHER CERTIFICATESS
OF OW
WNERSHIP
STOCK
K CONVERTED
SC0
03
(3)
PRINCIPAL PA
AYMENTS
SC14
((3)
DEBENTURES
SC0
04
(3)
EQUITY PAYM
MENTS
SC15
((3)
GOVER
RNMENT SECU
URITIES AND BO
ONDS
SC0
05
(3)
PROFITS
SC16
((3)
MUTUA
AL FUNDS
SC0
06
(3)
FUNDS PAID TO PURCHASE
E SHARES
SC17
((3)
WARRA
ANTS (RIGHTS))
SC0
07
(3)
FUNDS FOR STOCKS
S
SC18
((3)
BONDSS
SC0
08
(3)
SHARES OF STTOCK
SC19
((3)
DIVIDE
END REINVESTM
MENT SHARES
SC0
09
(3)
CASH FOR FR
RACTIONAL SH
HARES
SC20
((3)
CREDITT BALANCES
SC1
10
(3)
UNEXCHANG
GED STOCK
TANGIB
BLE PROPERTY
Y
SD0
01
(3)
SAFE DEPOSIT BOX CONTE
ENTS
SD04
((90 days)
STTORAGE FACILLITY SALE PRO
OCEEDS
TAX
T
DEFFERRED SAVINGSS PLANS
HS0
01
(2)
IR06
((2)
ROTH I RA MUTUAL FU
UNDS
IR07
((2)
ROTH I RA STOCKS
(2)
HEALTH SAVINGS ACCOUN
NT
HEALTH SAVINGS ACCOUN
NT
INVESTMENT
TRADITIONALL IRA CASH
HS0
02
(2)
IR01
1
IR02
2
CS01
((2)
ESA CA
ASH
(2)
TRADITIONALL IRA MUTUAL FUNDS
CS02
((2)
ESA MU
UTUAL FUNDS
IR03
3
(2)
TRADITIONALL IRA SECURITIES
CS03
((2)
ESA STO
OCKS
IR05
5
(2)
ROTH IRA CA
ASH
TRUST, IN
NVESTMENT AND
A
ESCROW
W ACCOUNTTS
TR01
(3)
PAYING AGE
ENT ACCOUNTTS
TR04
((3)
ESCRO
OW ACCOUNTTS
TR02
(3)
UNDELIVERED
D/UNCASHED DIVIDENDS
TR05
((3)
TRUST V
VOUCHERS
TR03
(3)
FUNDS HELD IN FIDUCIARY
Y CAPACITY
TRUS
STEE SALES
TS01
(2)
TRUSTEE SALE
ES PROCEEDS
UTILITIES
U
UT0
01
(2)
GOVERNMEN
NT UTILITIES
UT03
((3)
REFUND
DS OR REBATE
ES
UT0
02
(3)
MEMBERSHIP
P FEES
UT04
((3)
CAPITA
AL CREDIT DISTTRIBUTIONS
14
A
Arizona Unclaim
med Property Re
eporting Manua
al
CODE
C ES, TABL
T LES A
AND C
CHEC
CKLIST
Rela
ationship
p Codes//Paymentt Protoco
ols
eview the relationship code
es to ensure th
hat your comp
pany is indica
ating the corre
ect payment p
protocol.
Pleasse carefully re
Indiviidual names reported
r
witho
out a relationship code willl be coded ass payees. If th
here is more th
han one owne
er, you
must indicate the relationship fo
or each. All accepted
a
rela
ationship code
es are listed b
below.
Relation
R
nship Co
odes
Cod
de
Definition
n
Paymentt Protocol
AG Agent for Owner The individuaal or entity nameed as agent mayy claim property on behalf of thee individual(s) named as owneer(s). The Agentt will be required
d to provide verification that they continue
e to have autho rity to act on beehalf of the named owner. Paym
ment will be issued in the name of the ow
wner(s). Any naamed owner(s) m
may also receive payment by claiming on their own behalff. (Examples: Po
ower of Attorneey, Guardian, Atttorney for, Consservator) AD Administrator of Estate A person or e
entity appointedd by a court of coompetent jurisdiction to adminiister the estate of a pe
erson who has ddied (Examples: Executor, Executrix, and Person
nal Representative). Payment w
will be issued to
o the Estate. AN And (Unspecified Joint Relationship) Named indiviiduals must claim
m together or shhow good cause, such as divorcee or death, to claim sepaarately. If paid iindividually eachh owner will receeive an equal sh
hare. BF Beneficiarry Each individu
ual named as a bbeneficiary will bbe paid an equal share of the pro
operty. For non‐demutuaalization propertties only the inddividual named aas beneficiary will be paid. CF Custodian
n The individuaal or entity nameed as custodian can claim on beehalf of the indivvidual(s) named as ow
wner(s). Paymennt will be issued in the name of the owner(s). A
Any named owner(s) mayy also receive paayment by claim
ming on their own behalf. CP Community Property Property or e
earnings receive d by a husband and wife duringg marriage, other than by gift, devise, o
or descent. Eachh spouse should
d be listed as an owner and will be paid an equal share o
of the property.. Upon the deatth of one, the prroperty goes to tthe survivor. IN Insured Individuals naamed as the insuured will not be paid. The indivvidual named as beneficiary will be paid. If the beneficiarry is deceased and no successorr beneficiary exissts the property will be paid to the eestate of the inddividual named aas the insured. JS Joint Tenaants with Rights of Survivorship Each individu
ual named as a jjoint tenant witth rights of surviivorship will be paid an equal share o
of the property.. Deceased indivvidual’s portion of the property will be paid to the surviviing owner(s). OR Either Parrty is Owner First named individual/entityy who claims prooperty will be paaid the entire property. PA Payee Each individu
ual named as a ppayee will be paiid an equal share of the propertty. RE SO Remitter Sole Owne
er Each individu
ual named as a r emitter will be ppaid an equal sh
hare of the propeerty. The sole nam
med owner will bbe paid the property. Tenants in
n Common Each individu
ual named as a ttenant in comm
mon will be paid an equal share of the property unle
ess other percenntages are speciified. Deceased
d individual’s porrtion of the property will be treated as thhe estate of the individual and w
will pass as instructed by will, probate order or Arizonaa intestate statuutes. TE Trustee The individuaal or entity nameed as Trustee may claim propertty on behalf of tthe Trust. The Trustee w
will be required to provide veriffication that theyy continue to haave the authority to aact on behalf of the named ownner. Payment w
will be issued in the name of the Trust. UT Uniform TTransfer/Gift to M
Minor The minor orr guardian of thee minor may claim. Payment w
will be issued to tthe reported minor if theyy have reached tthe age of majo rity or otherwisse to the Custod
dian. TC 15
A
Arizona Unclaim
med Property Re
eporting Manua
al
CODE
C ES, TABL
T LES A
AND C
CHEC
CKLIST
Quiick Referrence Gu
uide
Make Checks Paya
able To:
Arizo
ona Department of Revenu
ue Unclaimed
d Property Uniit
Mail Repo
ort w/Remittan
nce To:
Arizo
ona Unclaime
ed Property Un
nit
1600
0 W Monroe Division
D
Code 10
Phoenix, AZ 85007
7
Stock Reg
gistration & De
elivery:
(See page
p
9)
Nom
minee name: Cactus
C
& Co
Tax ID #75-312166
66
a Markovich (617) 722-9660
0
Vilka
Xero
ox Business Services LLC
Mutual Funds:
(See Page
P
9)
Dividend Reinvestmentt Plans:
(See Page
P
9)
Safe Deposit Boxes:
(See Pa
age 10)
Remitt & Report Due
e Date:
Arizo
ona Department of Revenu
ue
Unclaimed Prope
erty Unit
Will NOT be acce
epted in bookk entry form
Con
ntact Vault Supervisor (602) 716-6035
Arizo
ona Department of Revenu
ue
Unclaimed Prope
erty Unit
1600
0 W Monroe Division
D
Code 10
Phoenix, AZ 85007
7
Priorr to Novembe
er 1st – all busin
nesses other than life insura
ance entities
For property
p
presu
umed aband
doned as of Ju
une 30
Priorr to May 1st – for
f all life insu
urance entitiess only
For property
p
presu
umed aband
doned as of December 31stt
Repo
orting Require
ements:
A NA
AUPA formattted file on CD
D ROM or USB fflash drive forr reports with 1
11 or more
prop
perties. Free software
s
avai lable (UPExch
hange)
Only
y 10 or fewer properties
p
ma
ay be submitte
ed manually. If you do not use
softw
ware to produ
uce your repo
ort, then you m
must use form
ms 650A or 650B and 652
(Sch
hedule A).
Aggregate
A
Rep
porting
Due Dilig
gence:
(See page
p
2)
Re
eciprocal Rep
porting:
Negative Reports
R
Sign
nature Require
ements
Due
e Diligence is not
n required o
on properties under $50. Pllease provide
e all
available owner detail
d
includin
ng those items under $50.
Must be mailed 120 days prior to report submission.
Hold
ders should report property
y to the state o
of the owner’s last known a
address. If
the property for other
o
states is submitted, it m
must be in co
ompliance with those
es’ laws and procedures.
p
state
Are not required in
i the State o f Arizona.
Hold
der report musst be signed b
by an authorizzed employee
e of the entity
y.
16
A
Arizona Unclaim
med Property Re
eporting Manua
al
CODE
C ES, TABL
T LES A
AND C
CHEC
CKLIST
Rem
mit Year Tables
T
NON
N-LIFE INSU
URANCE EN
NTITIES
One year abandonme
a
ent period
Items that were
w
issued or
o had a last activity
a
date
during the period:
Must be
e included on
n the report po
ostmarked be
efore:
7/01/2012 through
t
6/30//2013
Novem ber 1, 2014
7/01/2013 through
t
6/30//2014
Novem ber 1, 2015
7/01/2014 through
t
6/30//2015
Novem ber 1, 2016
7/01/2015 through
t
6/30//2016
Novem ber 1, 2017
Three yearr abandonment period
Items that were
w
issued or
o had a last activity
a
date
during the period:
Must be
e included on
n the report po
ostmarked be
efore:
7/01/2010 through
t
6/30//2011
Novem ber 1, 2014
7/01/2011 through
t
6/30//2012
Novem ber 1, 2015
7/01/2012 through
t
6/30//2013
Novem ber 1, 2016
7/01/2013 through
t
6/30//2014
Novem ber 1, 2017
LIFE INSURANC
CE ENTITIES
S
One year abandonme
a
nt period
Items that were
w
issued or
o had a last activity
a
date
during the period:
Must be
e included on
n the report po
ostmarked be
efore:
01/01/2013
3 through 12/3
31/2013
May 1, 2015
01/01/2014
4 through 12/3
31/2014
May 1, 2016
01/01/2015
5 through 12/3
31/2015
May 1, 2017
01/01/2016
6 through 12/3
31/2016
May 1, 2018
Three yearr abandonment period
Items that were
w
issued or
o had a last activity
a
date
during the period:
Must be
e included on
n the report po
ostmarked be
efore:
01/01/2011 through 12/3
31/2011
May 1, 2015
01/01/2012
2 through 12/3
31/2012
May 1, 2016
01/01/2013
3 through 12/3
31/2013
May 1, 2017
01/01/2014
4 through 12/3
31/2014
May 1, 2018
17
A
Arizona Unclaim
med Property Re
eporting Manua
al
CODE
C ES, TABL
T LES A
AND C
CHEC
CKLIST
Unc
claimed Property Terms
Aba
andoned or
o Unclaimed Property
Officia
al Check
Tangible (safe dep
posit box conttents) or intan
ngible
property that is unclaimed by its rightful owne
er after a
specified period of
o time. This do
oes not include real
estatte.
A checkk or written instrument for w
which a bank, financial
organiza
ation, or business associatio
on is directly lia
able,
including
g, but not limi ted to, drafts,, money orders,
traveler’ s checks, casshier’s checks, and expense
e checks.
Aba
andonmen
nt Period
Ownerr
The p
period of inac
ctivity after wh
hich property is
consiidered aband
doned.
A person
n having a leg
gal or equitab
ble claim to th
he
abando ned property
y.
Actiivity
Recorrd
Actio
on taken on property by the
e owner including
making a deposit or a withdraw
wal, negotiatin
ng a
chec
ck, or a docum
mented comm
munication by
y the
owne
er to the Holder.
Informattion that is insc
cribed on a ta
angible mediu
um or
that is sto
ored in any ellectronic or other medium and that
is retrieva
able in a perc
ceivable form
m.
Agg
gregate Am
mount
Reportt
The a
amount below
w which the Holder need no
ot perform
due d
diligence and
d attempt to contact
c
the owner
o
prior
to rep
porting funds as unclaimed
d property. The
aggrregate amoun
nt in Arizona iss $50. Please provide
p
all
d
available owner detail.
A list of o
owners and th
he value of their unclaimed
d
propertie
es that is filed with the Dep
partment on a
an annual
basis.
Cusstodian
Tangib
ble Persona
al Property
y
An in
ndividual or en
ntity that holds property until it is
delivered to the rig
ghtful owner. Most states’ la
aws make
the sttate the “custtodian” of abandoned pro
operty.
Physical property, suc
ch as objects kkept in safe deposit
boxes.
Underllying Share
es
Shares o f stock that have been issu
ued by a busin
ness
n. The original
associatiion or a financial institution
certificattes for the sha
ares are in the
e possession o
of the
sharehollders, who hav
ve failed to e
either cash the
e
d checks or co
orrespond witth the issuing
dividend
corporattion.
Date
e of Last Activity
A
The d
date of the ow
wner’s last acttivity related to
t the
property or the ow
wner’s contac
ct with the Holder.
Due
e Diligence
e
The statutorily requ
uired degree of effort a Holder of
aban
ndoned prope
erty must use to find the rig
ghtful
owne
er of property before the property is rem
mitted to
the State.
Hold
der
Any b
business, indiv
vidual, govern
nment body, or
o other
entity
y in possession
n or control off property belonging to
another party until transfer to a State unclaim
med
property program.
Inde
emnificatio
on
An agreement tha
at protects the
e Holder or Sta
ate from
loss.
18
A
Arizona Unclaim
med Property Re
eporting Manua
al
CODE
C ES, TABL
T LES A
AND C
CHEC
CKLIST
Che
ecklist
 Have you
y
entered
d the require
ed holder and
a
remitta
ance inform
mation on th
he front pag
ge of your
report form?
f
 Have you
y
enclose
ed your che
eck made payable
p
to:: Arizona De
epartment of Revenue
e
Unclaim
med Properrty Unit?
 Have you
y
enclose
ed your Schedule A? Is all of the available o
owner inform
mation included?
If reporting
g securities::




Have you
y
followed
d the Instructions for Se
ecurities Re
emittance?
Have th
he securitie
es been re-rregistered in
n the State of Arizona’s nominee
e name?
Have you
y
comple
eted the ap
ppropriate security
s
info
ormation on
n Schedule A?
Have you
y
enclose
ed notificatiion of any DTC
D
share ttransfer with
h your repo
ort submissio
on?
g mutual fun
nds:
If reporting
 Have th
he mutual funds
f
been transferred
d to an acc
count in the
e name of tthe Arizona
Departtment of Re
evenue, Unc
claimed Pro
operty Unit,, FEIN 86-60
004791?
 Have you
y
enclose
ed the mutu
ual fund confirmation sstatementss?
If reporting
g safe depo
osit boxes:
 Have you
y
followed
d the Instructions for Sa
afe Deposi t Remittanc
ce? (See pa
age 10)
 Have you
y
enclose
ed your Safe
e Deposit Box Report sseparately from your c
cash and se
ecurities
repots?
?
 Have you
y
enclose
ed a legible
e and reada
able copy o
of each inv
ventory sheet for each
h box
reporte
ed?
19
A
Arizona Unclaim
med Property Re
eporting Manua
al
ARIZONA FORM
DO NOT STAPLE REPORT/CHECKS
650A
Arizona Department of Revenue • Unclaimed Property Section
REPORT OF ABANDONED PROPERTY
If your report contains more than 10 items you MUST submit an electronic
file in NAUPA Standard Format. Form 652 (Schedule A) MUST be completed
if you are reporting 10 items or less and are not submitting an electronic file.
STOP
1
Entity Name (Holder)
DATE STAMP
If you are remitting securities, please use Arizona Form 650B
If you are remitting safe deposit box contents, please use Arizona Form 650C
Federal ID Number
State / Date of Incorporation
Prior Name - If Entity Name has changed
Previous Holder - If you are a successor to a previous holder
Contact Person - For questions from Unclaimed Property staff
Name
Direct Telephone Number
E-mail Address
Mailing Address
City
2
3
4
5
State
Customer Contact - For use by owners of reported property
 Same as Contact Person
Name ZIP code
Telephone Number
E-mail Address
Summary of Abandoned Property Reported
Total amount of properties under $50
In order to facilitate customer service, we request that, when
possible, you do not aggregate these funds in your report
$
Total amount of properties over $50 with known owners Total amount of properties with unknown owners Total Report Amount
$
$
$
4a. Remittance must accompany report.
4b. I have attached a true and correct list (Schedule A) of individual owners and properties, in accordance with A.R.S. § 44-307(B),
Reporting software is available for free download on our website www.azunclaimed.gov.
4c. I have reviewed and understand the State of Arizona payment protocols (see the Arizona Unclaimed Property Reporting Manual).
The relationship codes reported for each property will allow accurate payment to the reported owners.
4d. Written notice has been sent to the owners of all properties being reported/remitted in accordance with A.R.S. § 44-307(E).
I hereby certify that I have the authority to execute this report of Unclaimed Property on behalf of the above named holder. I declare under
penalty of perjury that the foregoing information, the information set forth in the schedules, and all documentation I have or will provide is
true and complete.
Print Name
Signature
Date
MAIL TO: Arizona Unclaimed Property Section  1600 West Monroe Street, Division Code 10  Phoenix, AZ 85007
Deposit No.
Check No.
ADOR 10755 (3/14)
FOR DEPARTMENT USE ONLY
Receipt No.
Check Amount
650B
1
STOP
Do NOT STAPLE REPORT/CHECKS
ARIZONA FORM
Arizona Department of Revenue • Unclaimed Property Section
REPORT OF ABANDONED SECURITIES
If your report contains more than 10 items you MUST submit an electronic
file in NAUPA Standard Format. Form 652 (Schedule A) MUST be completed
if you are reporting 10 items or less and are not submitting an electronic file.
Entity Name (Holder)
4
5
If you are remitting abandoned property, please use Arizona Form 650A
If you are remitting safe deposit box contents, please use Arizona Form 650C
Federal ID Number
State / Date of Incorporation
Prior Name - If Entity Name has changed
Previous Holder - If you are a successor to a previous holder
Contact Person - For questions from Unclaimed Property staff
Name
Securities Contact
Name
Direct Telephone Number
Direct Telephone Number
E-mail Address
E-mail Address
Mailing Address
Mailing Address
City
2
3
DATE STAMP
State
ZIP code
City
State
ZIP code
Customer Contact - For questions from owners of reported property
Telephone Number
 Same as Contact Person
Name E-mail Address
Summary of Abandoned Securities Reported
Total amount of properties under $50
In order to facilitate customer service, we request that, when
possible, you do not aggregate these funds in your report
$
Total amount of properties over $50 with known owners Total amount of properties with unknown owners Total Report Amount
$
Shares of Stock: Issue Name
$
Sent DTC
 Yes  No
$
Number of Shares
CUSIP No.
You are required to attach a verification statement to confirm transfer of shares. Remittance must accompany report.
Dividend reinvestment plans will not be accepted in book entry form. Each owner’s account must be converted into whole shares.
See the Arizona Unclaimed Property Reporting Manual 651 for detailed instructions.
For questions about the report or transfer of securities, call (602) 716-6032. For mutual funds questions, call (602) 716-6031.
4a. I have attached a true and correct list (Schedule A) of individual owners and properties, in accordance with A.R.S. § 44-307(B),
Reporting software is available for free download on our website www.azunclaimed.gov.
4b. I have reviewed and understand the State of Arizona payment protocols (see the Arizona Unclaimed Property Reporting Manual).
The relationship codes reported for each property will allow accurate payment to the reported owners.
4c. Written notice has been sent to the owners of all properties being reported/remitted in accordance with A.R.S. § 44-307(E).
I hereby certify that I have the authority to execute this report of Unclaimed Property on behalf of the above named holder. I declare under
penalty of perjury that the foregoing information, the information set forth in the schedules, and all documentation I have or will provide is
true and complete.
Print Name
Signature
Date
MAIL TO: Arizona Unclaimed Property Section  1600 West Monroe Street, Division Code 10  Phoenix, AZ 85007
Deposit No.
Check No.
ADOR 10756 (3/14)
FOR DEPARTMENT USE ONLY
Receipt No.
Check Amount
ARIZONA FORM Arizona Department of Revenue • Unclaimed Property Section
650C
1
REPORT OF SAFE DEPOSIT BOX CONTENTS
DATE STAMP
Entity Name (Holder)
Federal ID Number
Report Confirmation Number (see no. 3 below)
Holder Contact (for use by Unclaimed Property staff)
Name
Transfer/Reporting Agent Contact (for use by Unclaimed Property staff)
Name
Title
Title
Direct Telephone Number
Direct Telephone Number
E-mail Address
E-mail Address
Mailing Address
Mailing Address
City
2
State
ZIP code
City
Customer Contact (for use by owners of reported property)
Same as Holder Contact
Name
Telephone Number
4
5
ZIP code
E-mail Address
Mailing Address
State
City
3
State
ZIP Code
Summary of Safe Deposit Box Contents Reported
If you are remitting abandoned property, please use Arizona Form 650A
If you are remitting securities, please use Arizona Form 650B
Number of Safe Deposit Boxes Reported/Remitted
Previous Holder (If you are a successor to a previous holder of the property)
After submitting the report, contact the Unclaimed Property Vault Specialist to schedule delivery.
Do notsend safe deposit box contents without a report confirmation number from the Unclaimed Property Vault Specialist.
Attach a copy of this report with the report confirmation number you received to the safe deposit box contents you remit.
4a. I have attached a true and correct list (Schedule A) of individual owners and properties, in accordance with A.R.S. § 44-307(B).
Reporting software is available for free download on our website www.azunclaimed.gov.
4b. I have reviewed and understand the State of Arizona payment protocols (see the Arizona Unclaimed Property Reporting Manual)
The relationship codes reported for each property will allow accurate payment to the reported owners.
4c. Written notice has been sent to the owners of all properties being reported/remitted in accordance with A.R.S. § 44-307(E).
I hereby certify that I have the authority to execute this report of Unclaimed Property on behalf of the above named holder. I declare under penalty of perjury
that the foregoing information, the information set forth in the schedules, and all documentation I have or will provide is true and complete. Acting as the
authorized representative of the entity named above, I agree to indemnify the State of Arizona and hold it harmless against any and all claims, judgments,
decrees, costs, expenses (including reasonable attorney fees) or any other loss which either the State or owner might sustain in situations where the above
described property is destroyed, damaged, lost, or stolen during the delivery of the property to the State of Arizona by a third party.
Print Name
Signature
Mailing address: Arizona Unclaimed Property Section
Date
1600 West Monroe Street, Phoenix, AZ 85007
Deposit No.
FOR DEPARTMENT USE ONLY
Receipt No.
Holder No.
Check No.
Check Amount
Report No.
ADOR 10757 (9/10)
Previous ADOR 17-5623
ARIZONA FORM
650D
Arizona Department of Revenue • Unclaimed Property Section
NEGATIVE REPORT OF ABANDONED PROPERTY
DATE STAMP
1
Entity Name (Holder)
Federal ID Number
State / Date of Incorporation
Period Covered
Prior Name (if Entity Name has changed)
Previous Holder
Holder Contact (for use by Unclaimed Property staff)
Name
Direct Telephone Number
E-mail Address
Mailing Address
City
2
State
ZIP code
The undersigned declares under penalty of perjury, that to the best of his/her knowledge and belief, the above named entity has no
property which would be presumed abandoned under the Arizona Uniform Unclaimed Property Act for the period covered as stated and
that he/she is duly authorized to execute this report.
Print Name
Signature
Date
MAIL TO: Arizona Department of Revenue
Unclaimed Property Unit
1600 W Monroe Street, Division Code 10
Phoenix, AZ 85007
For assistance in the Phoenix area: (602) 364-0380 or outside the Phoenix area toll free: (877) 492-9957
To speak to the reporting specialist: (602) 716-6031
Fax: (602) 716-7997  www.azunclaimed.gov  Email: [email protected]
ADOR 11022 (3/14)
Previous ADOR 17-2009
ARIZONA FORM
652
Arizona Department of Revenue • Unclaimed Property Section
REPORT OF ABANDONED PROPERTY - SCHEDULE A
This Schedule A must accompany a Form 650A or 650B
and should be utilized ONLY if your report contains 10 items or less.
HOLDER NAME
Federal Employer Identification Number (FEIN)
Grand Total Remitted
$
Item no
Account #
Check #
NAUPA property type
Cash amount remitted
Interest rate
Owner’s last name
Owner’s first name / middle initial Owner’s mailing address
City, state, ZIP code
Country
Fee/Drilling cost
No. of shares remitted
Last activity date
Owner’s Tax ID (SSN or EIN) Owner’s date of birth
Security/Mutual Fund name
CUSIP no.
NAUPA relationship code
Date of Death
COMPLETE THE FIELDS BELOW IF THERE IS MORE THAN ONE OWNER FOR THIS PROPERTY
Additional owner’s last name
Additional owner’s date of birth
Additional owner’s first name / middle initial Additional owner’s Tax ID (SSN or EIN)
Additional owner’s date of death
Additional owner’s last name
Additional owner’s date of birth
Item no
Other information available
Additional owner’s first name / middle initial Additional owner’s Tax ID (SSN or EIN)
Additional owner’s date of death
Account #
Check #
NAUPA property type
Interest rate
Owner’s last name
Owner’s first name / middle initial Owner’s mailing address
City, state, ZIP code
Country
No. of shares remitted
Relationship code
Other information available
Cash amount remitted
Fee/Drilling cost
Relationship code
Last activity date (required)
Owner’s Tax ID (SSN or EIN) Owner’s date of birth
Security/Mutual Fund name
CUSIP no.
NAUPA relationship code
Date of Death
COMPLETE THE FIELDS BELOW IF THERE IS MORE THAN ONE OWNER FOR THIS PROPERTY
Additional owner’s last name
Additional owner’s date of birth
Additional owner’s last name
Additional owner’s date of birth
ADOR 11017 (3/14)
Additional owner’s first name / middle initial Additional owner’s Tax ID (SSN or EIN)
Additional owner’s date of death
Other information available
Additional owner’s first name / middle initial Additional owner’s Tax ID (SSN or EIN)
Additional owner’s date of death
Relationship code
Relationship code
Other information available
PAGE OF Arizona Department of Revenue
ARIZONA FORM
670
1
HOLDER REIMBURSEMENT REQUEST FORM
Owner Information
Report Year
Report Amount
Property Type Code
Aggregate
Property Amount
YES
NO
Owner’s Name as Indicated on Report
Additional Owner as Indicated on Report
Owner’s Street Address
Owner’s City or Town
Owner’s State
Owner’s ZIP Code
State
ZIP Code
Property Description
2
Holder Information
Holder Name
Tax Identification Number
Mailing Address
City or Town
3
4
Contact Person
Title
Telephone Number
E-mail Address
I depose and swear under oath that I am authorized to make this affidavit as a duly authorized officer. Based upon personal knowledge, the
information provided by the reporting institution (holder) to substantiate payment to the owner or reinstatement of the remitted account is true and
correct. By demonstrating that the owner, or his/her personal representative was paid or reinstated, I hereby certify this claim for reimbursement
is valid and just. Upon payment by the Arizona Department of Revenue of the reimbursement described above, the reporting institution (holder),
herein named, agrees to indemnify and hold harmless the State of Arizona, its employees and agents from any and all liability, claims, demands,
losses, suits, or actions, arising from or related to any other party who hereafter asserts or attempts to establish right to payment of the above
described funds to the extent of the value of the property so paid or delivered.
Signature
Date
Subscribed and Affirmed before me by:
this
day of
State of
Notary Public Signature
, 20
.
County of
(Affix Seal Here)
MAIL TO: Arizona Department of Revenue Unclaimed Property Unit PO Box 29026 Phoenix, AZ 85038-9026
For assistance in the Phoenix area: (602) 364-0380 or outside the Phoenix area toll free: (877) 492-9957
Fax: (602) 542-2089 www.azunclaimed.gov
ADOR 17-2022 (9/09)
Arizona Department of Revenue • Unclaimed Property Section
1600 W Monroe • Phoenix, AZ 85007
REPORT OF ABANDONED PROPERTY
Verification and Checklist
Verification for Period Ended:
Every person, corporation or other business association, banking or financial organization, life insurance corporation, utility, court or public authority must complete the
following checklist before filing their Arizona Annual Report of Property Presumed Abandoned. This checklist includes by way of illustration, but not limitation, those
items which are covered by Section 44-301 et seq of the Arizona Revised Uniform Unclaimed Property Act. All of the following types of property, with the exception
of travelers checks must be reported if they have remained unclaimed for one or more years. Travelers checks should be held fifteen (15) years. Please complete
the checklist by checking the box next to each applicable item.
ACCOUNT BALANCES
A. Checking accounts
B. Savings accounts
C. Matured certificates of deposit or savings certificates
D. Christmas Club accounts
E. Money on deposit to secure funds
F. Security deposits
G. Unidentified deposits
H. Suspense accounts
I. Any sum owing to a shareholder, certificate holder, member,
bond holder or other security holder, or participating member of a
cooperative, such as:
1. dividends
2. interest
3. principal payments
4. equity payments
5. profits
6. other distributions
J. Escrow funds
TRUST, INVESTMENT AND ESCROW ACCOUNTS
A. Paying agent accounts
B. Unclaimed dividends
C. Funds held in a fiduciary capacity
D. Funds paid toward the purchase of shares, or interest in a financial or
business organization
E. Funds received for redemption of stocks and bonds
F. Stocks
G. Bonds
H. Any other certificates of ownership
I. Suspense liabilities
UTILITIES
A. Utility deposits
B. Membership fees
C. Refunds or rebates
COURT DEPOSITS
A. Escrow funds
B. Condemnation awards
C. Missing heirs funds
D. Suspense accounts
E. Victim’s restitution
F. Any other type of deposit made with a court or public authority
TANGIBLE PROPERTY
A. Contents of safe deposit boxes
B. Contents of any other safekeeping repository
C. Other tangible property
ADOR 11017 (8/11)
MISCELLANEOUS CHECKS AND INTANGIBLE PERSONAL PROPERTY
HELD IN THE ORIDINARY COURSE OF BUSINESS
A. Wages, payroll or salary
B. Commissions
C. Expense checks
D. Workman’s Compensation benefits
E. Pension checks
F. Credit checks or memos
G. Payments for goods and services
H. Customer overpayments
I. Unidentified remittance
J. Unrefunded overcharges
K. Accounts payable
L. Credit balances - accounts receivable
M. Discounts due
N. Refunds
O. Unredeemed gift certificates
P. Vendor checks
Q. Mineral proceeds
R. Royalties
S. Any other miscellaneous outstanding checks
T. Any checks that have been written off to income or surplus
U. Any other miscellaneous intangible personal property
OFFICIAL CHECKS
A. Certified checks
B. Cashier’s checks
C. Registered checks
D. Treasurer’s checks
E. Drafts
F. Warrants
G. Money orders
H. Travelers checks
I. Foreign exchange
J. Any other official checks or exchange items
DISSOLUTIONS
A. All property distributable in the course of voluntary or involuntary
dissolution or liquidation which is unclaimed within one year after the
date for final distribution is presumed abandoned.
INSURANCE
A. Amounts due and payable under terms of insurance policies
B. Claim payments
C. Drafts unpresented for payment
D. Matured whole life, term or endowment insurance policies or annuity or
supplementary contracts
E. Other amounts due under policy terms