Detail Report for Unclaimed Property - Washington
WARNING: To protect against the possibility of others accessing your confidential
Washington State Department of Revenue Unclaimed Property Section
PO Box 34053
Seattle, WA 98124-1053
360-534-1502 (option 4)
information, do not complete these forms on a public workstation.
Detail Report for Unclaimed Property
Reset This Form
Holder Name Holder Number
Report Year
Primary Owner Last Name
First Name
Middle Initial Relation to 1st owner:
Title
Date of Birth
SSN/FEIN
Complete Secondary Owner Information If There Is More Than One Owner For This Property
Secondary Owner Last Name
First Name
Middle Initial
Title
Date of Birth
SSN/FEIN
Relationship to Primary
Owner Address
City
State
Zip
Monetary Property
Category Code Original Amount Deduction Amount Deduction Type Interest Rate
Primary Owner Last Name
Municipal Reporting
Property Retained Per RCW 63.29.190
Additional Information
ID Number ID Number Last Activity Date
First Name
Securities (stock)
Category Code CUSIP Number of Shares
Middle Initial Relation to 1st owner:
Title
Date of Birth
SSN/FEIN
Complete Secondary Owner Information If There Is More Than One Owner For This Property
Secondary Owner Last Name
First Name
Middle Initial
Title
Date of Birth
SSN/FEIN
Relationship to Primary
Owner Address
City
State
Zip
Monetary Property
Category Code Original Amount Deduction Amount Deduction Type Interest Rate
Municipal Reporting
Property Retained Per RCW 63.29.190
Additional Information
ID Number ID Number Last Activity Date
Securities (stock)
Category Code CUSIP Number of Shares
Page
of
Page Total $
Grand Total $
For assistance visit ucp.dor. or call 360-534-1502. To inquire about the availability of this document in an alternate format, please call
360-705-6705. Teletype (TTY) users may use the Washington relay Service by calling 711.
REV 80 0008 (7/12/19)
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