Unclaimed Property General Claim Form - City Of Round Rock Finance Department printable pdf download

City of Round Rock

Mail to: City of Round Rock

Unclaimed Property

Finance Department

General Claim Form

Unclaimed Property

221 East Main Street

Round Rock, TX

78664

Claimant Information (Claimant must be 18 or older to claim property)

Name of Claimant

First

Middle

Last

Current Mailing Address

PO Box, Street, Etc.

Building, Suite, Apartment Number

City

State

Zip Code

Your Status (Check one box below, attach documents requested AND enter the applicable federal identification number below)

If you are an HEIR to the owner, send a copy of probated will OR court order OR affidavit of heirship listing heirs and current addresses AND a copy of the

death certificate of the owner. Deceased owner information needed below.

If you are a TRUSTEE OR GUARDIAN to the owner, send copies of current documents establishing guardianship of trust.

If you are an EXECUTOR or ADMINISTRATOR for the owner's estate, send a copy of the death certificate AND Letters of Admistration OR Testamentary

dated within 90 days of filing the claim. Deceased owner information needed below.

If you are an OFFICER OF THE ORGANIZATION, send current documents establishing your authority to act for the organization.

If you are a PARENT of the owner who is under age 18, attach a copy of the minor's birth certificate and proof of SSN

FILL IN FEDERAL NUMBERS THAT APPLY:

Deceased SSN

Estate Trust Company TPID#

Daytime phone number

Other Phone

(In Case we need to contact you in regards to your claim)

Identifying Information

This information is necessary to validate proof of ownership of the property and will remain confidential

SSN or TPIN

Previous Address

Attachments

The following documents must be sent along with this claim form for the claim to be considered complete and valid

A) Proof of Claimant's Social Security Number

B) Copy of Claimant's Driver's License or any Official form used for indentification

C) Proof of previous address (Copy of utility bill, canceled check, etc.)

Claimant Signature

The named Claimant hereby certifies that this claim for property presumed abandoned is valid and just, that all statements herein are true and correct,

and that upon payment of this claim said Claimant will indemnify and hold harmless the City of Round Rock, and it' s officers and employees for any

damages, claims or losses of any kind resulting from the payment of the above described property to the Claimant.

Claimant

Date

Co-Owner

Date