Unclaimed Property Safekeeping Inventory Form Page 2
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2THIS SECTION TO BE USED IF CONTENTS BECOME UNCLAIMED
Contents turned over to the state of Nevada as Unclaimed Property under NRS120A.510 on this date_______________
_______________________________________
_______________________________________
Signature of State Official
Signature of Holder Official
The Nevada State Treasurer, as the administrator of Unclaimed Property, takes custody of the contents shown for the above listed
owner(s) and is responsible for its safekeeping. The holder is relieved of all liability to the extent of the value of the property delivered
for any claim which then exists or which thereafter may arise or be made in respect to the property (NRS 120.570).
(See Reverse)
— FOR BANK USE ONLY —
That thereafter the contents of such safe deposit box were:
Sealed in a package by the undersigned notary public, together with a duplicate of this certificate and the name of the
lessee and the date of opening of the safe deposit box were written on the outside of the package by the undersigned
notary public in the presence of a bank officer, and a copy of this certificate was sent by certified mail, addressed to the
lessee at the last known address of the lessee (NRS 663.085).
Mailed to the lessee by certified or registered mail in accordance with lessee’s written instructions dated:
__________________________________________________
Released to ___________________________________________________ (Agency) in accordance with search warrant
dated __________________________________________.
Returned to the safe deposit box in total.
Returned to the safe deposit box with the exception of
_______________________________________________________
which was released to________________________________________________________ in accordance with court order
dated ___________________________________________________________.
Other
____________________________________________
Signature of Acceptor of Property
In witness whereof, we have hereunto set our hands at _____________________________, Nevada, this ___________day
Of _______________________________, 20 _________.
____________________________________________
Signature of Bank Officer
State of Nevada, County of _______________________
Signed and sworn to before me on _________________ by
______________________________________________
Signature of Notary Public
Date rent last paid____________________________________
Charge for forcible entry
$____________________
Safekeeping charge
$_________________
Unpaid Rent
$____________________
Balance owed by Renter
$_________________
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