Print Form
STATE OF KANSAS
Lynn Jenkins, CPA
TELEPHONE
900 SW JACKSON ST. SUITE 201
TREASURER
(785) 296-3171
TOPEKA, KANSAS 66612-1235
KS Unclaimed Property Request to Escheat Property Prior to Required Dormancy Period
*You still must follow due diligence requirements when escheating property early*
Business Name _____________________________________ Tax ID # ___________________
Business Address _______________________________________________________________
Contact Name ________________________________ Contact Phone # ___________________
Fax # ____________________________________
A copy of the completed request will be faxed to you.
Please explain your business' need for escheating property prior to the required dormancy period
(you may attach a letter or other supporting documents):
What types of property does this request cover?
(Ex., patient balances, outstanding checks, estate funds)
Is this request to apply to all future reports from your business?
Yes
No
If No, please specify the report date this request applies to: _______________________
(Approximate filing date)
Return the signed request to:
or fax to:
Holder Department
Unclaimed Property - Holder Services
900 SW Jackson, Suite 201
(785)291-3172
Topeka, KS 66612-1235
Authorized Business Representative __________________________________ Date _____________
KS Unclaimed Property Representative ________________________________ Date _____________
Escheatment prior to the required dormancy period has been approved with the following terms:
Escheatment prior to the required dormancy period is denied.
Visit our website at
for report forms, FAQ's and on-line reporting information.
Contact our UCP Holder Department with any questions at (785) 291-3173.