Unclaimed Property Safekeeping Inventory Form
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1
2NEVADA STATE TREASURER ● UNCLAIMED PROPERTY
SAFEKEEPING INVENTORY
Holder Name _______________________________________________________________ Holder No. __________
Owner Name(s) ________________________________________________________ SS#/TIN ________________
Street Address _________________________________________________________________________________
City, State, Zip _________________________________________ Box#/Patient#/Other# ______________________
On this __________ day of ___________________, 20________, the contents listed below were removed, securely
wrapped, and the package plainly marked with the names(s) of the owner(s) and placed in joint custody.
No. of
Officer’s
Notary
Description of Contents
Items
Initials
Initials
____________________________________________
_____________________________________________
Official Signature
Notary Public Signature
Contents released to owner(s) on ______________________________
____________________________________________
_____________________________________________
Signature of owner
Witness (Official signature)
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Parent category: Financial