Unclaimed Property Business Claim Form - City Of Round Rock Finance Department
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1City of Round Rock
Mail to: City of Round Rock
Unclaimed Property
Finance Department
Business Claim Form
Unclaimed Property
221 East Main Street
Round Rock, TX
78664
Claimant Information (Claimant must be 18 or older to claim property)
Business Name
Name of Claimant
First
Middle
Last
Current Mailing Address
PO Box, Street, Etc.
Building, Suite, Apartment Number
City
State
Zip Code
Your Business Status (Check box(es) below, attach documents requested AND enter the applicable federal identification number below)
TEXASCORP, LLC or Professional Corporation. Attach a copy of last Franchise Tax report filed. (If out of state corporation, same as above
including State of Corporation)
Professional Association or Non-Profit Corporation. Attach a copy of last Annual Statement filed with the Secretary of State or copy of Articles
of Incorporation
Private organization, group or association. Attach a document establishing your authority to act.
Sole ownership of business. Attach a Copy of Certificate To Operate Under Assumed Name filed with the County Clerk and enter
Owner's Name
SSN
A Limited or General Partnership. Attach a copy of partnership agreement including names and SSN of two partners
EXCEPTION, IF BUSINESS IS:
Out of business (Closed). Attach a brief statement of closing and a copy of the Articles of Dissolution or Corporation Liquidation
Form filed with the IRS
Name Changed/Assumed/Merged. Attach copy of change of Name Amendment or Assumed Name Certificate
Purchased/Sold. Attach a copy of Buy/Sell Agreement.
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
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Parent category: Financial