Holder Reporting Extension Request Form

ADVERTISEMENT

NORTH CAROLINA
DEPARTMENT OF STATE TREASURER
UNCLAIMED PROPERTY / ESCHEATS DIVISION
____________________________________________________________________________________
BRENDA D. WILLIAMS
JANET COWELL
TREASURER
DEPUTY TREASURER
STATE OF NORTH CAROLINA
HOLDER REPORTING EXTENSION REQUEST
Holders unable to submit their report by the scheduled due date, may request an extension in
accordance with NCGS 116B-60(e). Such request may be granted for good cause.
Please complete this form for each entity or company.
Holder # (if known) ______________________
Holder Name: ___________________________________________ FEIN: ___________________________
Mailing Address: __________________________________________________________________________
Reason for requesting extension:
Personnel Change
Merger/Acquisition
New Accounting System
Other (Please explain) __________________________________
Requesting the following additional time to submit report:
30 days
60 days
90 days
120 days
Enclosed is an estimated payment of $ ______________ for this request.
Check(s) should be made payable to NC Department of State Treasurer.
Contact Name (print): ____________________________________
Telephone: ___________________
Contact Email Address: ____________________________________________________________________
Signature: ________________________________________________
Date: _________________________
Mail completed form, extension fee and estimated payment to:
BRENDA D. WILLIAMS, DEPUTY TREASURER
N C Department of State Treasurer - Unclaimed Property Program
325 North Salisbury Street, Raleigh NC 27603-1385
If you have questions, please call 919-508-5939, or via email at
.
TREASURER’S OFFICE USE ONLY
Request for an extension has been granted. Report is due on: _______________________________
Request for an extension has been denied. Please report and remit on or before the due date as
required by statute.
Approved by: ___________________________________ Date: ______________________________________
325 NORTH SALISBURY STREET, RALEIGH, NORTH CAROLINA 27603-1385
Telephone (919) 508-1000
Fax (919)508-5181

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Holder Reporting Extension Request Form - Connecticut Office Of The State Treasurer Holder Reporting Extension Request Form - Connecticut Office Of The State Treasurer Legal
Holder Reporting Extension Request Form - Connecticut Office Of The State Treasurer - 2012 Holder Reporting Extension Request Form - Connecticut Office Of The State Treasurer - 2012 Legal
Holder Reporting Extension Request Form - Connecticut Trasurer's Office - 2011 Holder Reporting Extension Request Form - Connecticut Trasurer's Office - 2011 Financial
Unclaimed Property Holder Reporting Extension Request Form - Kentucky Department Of Treasury Unclaimed Property Holder Reporting Extension Request Form - Kentucky Department Of Treasury Financial
Unclaimed Property Holder Reporting Extension Request Form - Kentucky Department Of Treasury - 2008 Unclaimed Property Holder Reporting Extension Request Form - Kentucky Department Of Treasury - 2008 Legal
Unclaimed Property Holder Reporting Extension Request Form - Kentucky Department Of Treasury Unclaimed Property Holder Reporting Extension Request Form - Kentucky Department Of Treasury Financial
Form Ucp-135 - Holder Request For 60 Day Extension Of Due Date For Holder Report Form Ucp-135 - Holder Request For 60 Day Extension Of Due Date For Holder Report Legal
Form Erf - Extension Request Form Form Erf - Extension Request Form Financial
Form Er - Extension Request Form - City Of Loveland - Income Tax Department Form Er - Extension Request Form - City Of Loveland - Income Tax Department Financial
Extension Request Form-city Of Blue Ash Extension Request Form-city Of Blue Ash Financial

Related Categories

Parent category: Legal
Download
Go