Instructions for Unclaimed Property Self-Audit

STATE OF WASHINGTON

DEPARTMENT OF REVENUE

Instructions for Unclaimed Property Self-Audit

HOW DO I COMPLETE THE SELF-AUDIT? ? To complete this Self-Audit you will first need to (1) read all the instructions below; and (2) fill out the attached worksheet. Once you complete the worksheet you will have all the information necessary to fill out the online Self-Audit. ? Before submitting the Self-Audit, a company representative will need to certify that all the information submitted is complete and accurate to the best of their knowledge. ? Please note that for data security reasons, you will need to complete the entire online Self-Audit form at one time. If you leave the Self-Audit online form before completing all of the questions and hitting "submit," your answers will not be saved.

WHAT INFORMATION DO I NEED TO COMPLETE THE WORKSHEET? ? To complete the worksheet, you will need to review your financial records from 7/1/2010 to the present, including: o account ledgers; o banking records; o uncashed and voided check listings (including checks issued by third-party administrators); o accounts payable and receivable sub-ledgers; and o accounts used to monitor suspended or unidentified funds.

? In reviewing your records, you will need to review any past write-offs of outstanding liabilities. It is unlawful to write-off or reclassify unclaimed property as income, as an expense reduction or otherwise. Write-offs of unpaid liabilities may be reflected in journal entries and miscellaneous income accounts, among other records.

? Please note that you will need property and owner information, including last known address, from your books and records in order to complete the Self-Audit.

? Although you do not need to submit any supporting documentation with your Self-Audit, you must ensure that all records used to complete the Self-Audit are preserved. Upon review of your responses, you may be asked to submit additional information.

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STATE OF WASHINGTON

DEPARTMENT OF REVENUE

IMPORTANT CONSIDERATIONS WHEN COMPLETING THE WORKSHEET AND SUBMITTING THE SELF-AUDIT:

? When answering questions regarding property that may fall into more than one category, select the most appropriate category and report it only once.

? If you have previously reported any unclaimed property, please only include that information in the Reporting History section. Do not include these amounts in your other responses.

? For Washington State domiciled companies, you may use any reasonable method of estimation to determine unclaimed property due in any year for which records are not available.

? To the extent you have written-off outstanding liabilities, you must include any such write-offs in your responses to the appropriate property sections concerning potential unclaimed property you may be holding. For example, if you previously wrote-off small or aged credit balances due to customers, the amounts written off should be included in your answers to the question concerning outstanding credit balances.

? Prior to annual reporting and remitting of unclaimed property to the Department, companies are required to send written notice to each property owner stating that they are in possession of the owner's property if (1) the holder has in its records an address for the apparent owner which the holder's records do not disclose to be inaccurate; (2) the claim of the apparent owner is not barred by the statute of limitations; and (3) the property has a value of more than seventy-five dollars. This process is referred to as "due diligence." Washington State's Unclaimed Property Act, RCW 63.29.170(6). After you submit the online Self-Audit, you may be required to conduct due diligence. You will be provided with due diligence instructions and a sample due diligence letter at that time.

COMPANIES WITH SUBSIDIARIES: ? If your company has subsidiaries, your answers to the Self-Audit should include property held by those subsidiaries. ? If it would be too difficult for you to coordinate the inclusion of subsidiary information into your SelfAudit response (e.g., you do not have a centralized accounting system), each subsidiary may submit a separate Self-Audit. ? If you will be submitting separate Self-Audits for each subsidiary, you will need to modify your case number. For the first Self-Audit you submit, use the case number on the Self-Audit notice. For each additional Self-Audit submitted, number sequentially using the same case number followed by a dash and a number (e.g. XXXXX-1, XXXXX-2, XXXXX-3).

For assistance, contact Verus Analytics at upaudit@ or (646) 461-4177. Page 2 of 10

STATE OF WASHINGTON

DEPARTMENT OF REVENUE

Unclaimed Property Self-Audit Worksheet

Please note that you will be unable to answer most of the questions on the online Self-Audit form unless you first fill-out the below Worksheet.

Please also note that before you begin the online Self-Audit form, you will need to confirm the following: I reviewed all of the instructions to the Worksheet. I agree to answer all questions accurately and honestly to the best of my knowledge. I understand that failure to accurately complete this Self-Audit may result in the initiation of an on-site

audit with the potential for the imposition of penalties and interest.

1. Company Information

a. Case Number (from Self-Audit notice)

b. Full Company Name c. Doing Business As (DBA) d. Industry e. Business Description

f. Principal Address g. City h. State i. Zip (5 Digit) j. Federal Employer ID Number (FEIN)

k. State of Incorporation

l. Year of Incorporation

m. Current Number of Full-time Employees

n. Current Number of Part-time Employees

o. Approximate Prior Year Revenues

$

p. Contact Name

q. Contact Title

r. Contact E-mail

s. Contact Phone (including extension)

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STATE OF WASHINGTON

DEPARTMENT OF REVENUE

2. Subsidiaries (applicable to companies with subsidiaries) If your company has subsidiaries, your answers to the Self-Audit should include property held by those subsidiaries.

a. Identify your subsidiaries by name and FEIN.

b. Will your responses below include answers on behalf of your subsidiaries? (yes or no)

If it would be too difficult for you to coordinate the inclusion of subsidiary information into your Self-Audit response (e.g., you do not have a centralized accounting system), each subsidiary may submit a separate Self-Audit. If you will be submitting separate Self-Audits for each subsidiary, you will need to modify your case number. For the first Self-Audit you submit, use the case number on the Self-Audit notice. For each additional Self-Audit submitted, number sequentially using the same case number followed by a dash and a number (e.g. XXXXX-1, XXXXX-2, XXXXX-3).

3. Unclaimed Property Reporting a. Do you follow a written policy or procedure regarding the identification and reporting of unclaimed property? (yes or no)

b. Have you ever reported unclaimed property to Washington State? (yes or no)

i. Identify years and amounts reported for the last ten years. c. Have you ever reported unclaimed property to states other than Washington State? (yes or no)

i. Identify the states, most recent report year, and amounts reported. d. Has another entity ever reported unclaimed property to Washington State on your behalf (e.g., parent entity or third party administrator)? (yes or no)

i. Identify the entity, FEIN, most recent report year, and amount reported.

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STATE OF WASHINGTON

DEPARTMENT OF REVENUE

4. Accounting Information a. Were records available from 7/1/2010 to present? (yes or no)

i. Which years were unavailable?

For Washington State domiciled companies, you may use any reasonable method of estimation to determine unclaimed property due in any year for which records were not available.

b. Has the company had an accounting system conversion in the last 10 years? (yes or no)

i. If yes, are you aware of any liabilities that were not migrated from the prior system to the new system? (yes or no)

Any outstanding liabilities that were deleted in the process of migration should be included in your answers to the questions in this Self-Audit concerning outstanding liabilities.

ii. Are you aware of any dates that were changed as a result of the conversion? (yes or no)

In calculating whether an outstanding liability meets the dormancy period, the date the liability was originally created should be used--not any new date that was created during the conversion.

c. Have any liabilities been written off or reclassified to income to remove small or aged balances, to adjust an unidentified account, or otherwise in the last 10 years? (yes or no)

In reviewing your records, you will need to review any past write-offs of outstanding liabilities and include any such write-offs in your responses to all questions concerning potential unclaimed property you may be holding.

5. Uncashed Checks (excluding payroll)

a. Value of all uncashed checks, excluding payroll, that were originally

$

issued between 7/1/2010 and 6/30/2017

Include all liabilities associated with checks that remain outstanding. This includes checks that were voided then reissued, and remain unpaid. If a check was voided and reissued, use the check's original issue date. For checks that were voided and never reissued, if the underlying liability was never satisfied, include the value of those voided checks in your answer.

Include insurance-related uncashed checks in the Insurance section found later in this form.

For assistance, contact Verus Analytics at upaudit@ or (646) 461-4177. Page 5 of 10

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