ARKANSAS UNCLAIMED PROPERTY

ARKANSAS

UNCLAIMED PROPERTY

REPORTING BOOKLET

--IMPORTANT--

UNCLAIMED PROPERTY REPORTS ARE DUE BY OCTOBER 31

(APRIL 30 FOR LIFE INSURANCE COMPANIES)

Complete your report online at

www.auditorjimwood.org

-OR-

Mail your completed report and remittances to:

Auditor of State

Unclaimed Property Division

P.O. Box 251906

Little Rock, AR 72225-1906

For additional information please visit our website, www.auditorjimwood.org

STEPS TO COMPLETE YOUR REPORT

1. Your accountant or controller should search your records for any unclaimed funds your

organization may be holding. See the Property Type Codes & Abandonment Periods

schedule on P.4 for types of reportable funds.

2. If a diligent search has shown that your organization is not holding any unclaimed funds,

file a negative report using the Transmittal (AOS/UP1) form on P.6. Mark the “negative”

box in the “Type of Report” section. Please note that a “negative” report will be necessary

only for organizations that have had property to report to us in the last three years.

3. Issue due diligence letters to the property’s owners between 60 and 120 days before filing

your report. Due diligence letters must be issued for all items $50.00 and over, when the

address on record may be accurate. See pages 16 and 17 for sample due diligence letters.

4. Choose a method of reporting after reviewing the following information on reporting

methods. Indicate your “method of reporting” selection on AOS/UP1. The Division of

Unclaimed Property (“Division”) requires holders to utilize NAUPA electronic reporting

when the number of records exceeds 100.

ONLINE

You can use our website, www.auditorjimwood.org, to either submit your report

electronically or complete a paper report to mail in to us. With this method of reporting,

you do not need to fill out any of the forms in this booklet.

DISKETTE OR CD-ROM

NAUPA electronic reporting is required for holders reporting more than 100 records, but

can be used for reports of any size. For NAUPA text file formatting guidelines, please go to

our website at www.auditorjimwood.org/pdf/naupa-revised-standard.pdf. Your diskette or

CD-ROM must be accompanied by a completed AOS/UP1 form.

PAPER FORMS

To report by paper, complete the applicable forms contained in this packet. All forms may

be duplicated. Basic information about your organization and summary information about

your unclaimed property report should be provided on AOS/UP1 on P.6. Owner detail for

your report should be provided on AOS/UP2, AOS/UP3, AOS/UP4, and/or AOS/UP5. A

computer printout is acceptable for owner detail if all required information is included.

5. Complete your report. For your convenience, statute allows items under $50.00 to be

lumped together into a single “aggregate” amount. The Division, however, prefers to have

only items under $25.00 lumped together as an “aggregate” amount. Stock, safe deposit

box contents, and all other non-cash items must be listed individually.

6. You can deliver your report, remittance, and safe deposit box contents using the delivery

instructions on P.2. See P.12 for securities delivery instructions.

7. If you have any questions, please e-mail us at ho[email protected] or call us at

501-682-9174.

DELIVERY INSTRUCTIONS

Unclaimed property reports, remittances, and securities can be delivered using the

following methods:

ACH TRANSFER:

ABA #082000109

WIRE TRANSFER:

Regions Bank Arkansas

ABA #062005690

FOR BENEFIT OF:

Auditor of State account #8009152660

The holder must confirm all transfers via fax to (501) 683-4285

Attn: Kaye Hairston

BY MAIL:

Regular delivery:

Auditor of State, Unclaimed Property Division

P.O. Box 251906

Little Rock, AR 72225-1906

Special delivery requiring physical address:

Auditor of State, Unclaimed Property Division

1401 West Capitol Avenue, Suite 325

Little Rock, AR 72201

BY FAX:

(501) 683-4285

NOTE: Receipt of funds does not relieve the holder from the obligation to file

the detailed report under Arkansas Code Section 18-28-207 on or before the due

date.

REPORTING CODES

RELATIONSHIP CODES

AD Administrator GR Guardian

AF Attorney For IN Insured

AG Agent For JC Joint Tenants in Common

AN And JT Joint Tenants with Rights

AO And/Or of Survivorship

BF Beneficiary OR Or

CC Co-Conservator PA Payee

CF Custodian For PO Power of Attorney

CN Conservator RE Remitter

EX Executor or Executrix TE As Trustee For

FB For Benefit of UG Unified Gift to Minors Act

DEDUCTION AND WITHHOLDING CODES*

DR Drilling Fees & SC Storage Charges

Unpaid Rent

*Note: Decuction and withholding codes are used only for reporting safe deposit boxes or other

safekeeping items on AOS/UP5.

Account Balances Due (1) Court Deposits (6)

Yrs Code Description Yrs Code Description

5 AC01 Checking Accounts 1 CT01 Escrow Funds

5 AC02 Savings Accounts 1 CT02 Condemnation Awards

5 AC03 Matured CD or Savings Certificates 1 CT03 Missing Heirs' Funds

5 AC04 Christmas Club Funds 1 CT04 Suspense Accounts

5 AC05 Money on Deposit to Secure Funds 1 CT05 Other Court Deposits (Including Class Actions)

5 AC06 Security Deposits 1 CT99 Aggregate Court Deposits (Under $50)

5 AC07 Unidentified Deposits

5 AC08 Suspense Accounts Insurance (7)

5 AC99 Aggregate Account Balances (Under $50) Yrs Code Description

5 IN01 Individual Policy Benefits or Claim Payments

Uncashed Checks (2) 5 IN02 Group Policy Benefits or Claim Payments

Yrs Code Description 3 IN03 Proceeds Due Beneficiaries

5 CK01 Cashier's Checks 3 IN04 Proceeds From Matured Policies, Endowments,

5 CK02 Certified Checks or Annuities

5 CK03 Registered Checks 5 IN05 Premium Refunds

5 CK04 Treasurer's Checks 5 IN06 Unidentified Remittances

5 CK05 Drafts-Checks 5 IN07 Other Amounts Due under Policy Terms

5 CK06 Warrants 3 IN08 Agents' Credit Balances

7 CK07 Money Orders 5 IN99 Aggregate Insurance Property (Under $50)

15 CK08 Traveler's Checks

5 CK09 Foreign Exchange Checks Securities (8)

5 CK10 Expense Checks Yrs Code Description

5 CK11 Pension Checks 5 SC01 Dividends

5 CK12 Credit Checks or Memos 5 SC02 Interest (Bond Coupons)

5 CK13 Vendor Checks 5 SC03 Principal Payments

5 CK14 Checks Written off to Income 5 SC04 Equity Payments

5 CK15 Other Outstanding Official Checks 5 SC05 Profits

5 CK16 CD Interest Checks 5 SC06 Funds Paid to Purchase Shares

5 CK99 Aggregate Uncashed Checks (Under $50) 5 SC07 Funds for Stocks & Bonds

5 SC08 Shares of Stock (Returned by P.O.)

Mineral Proceeds & Mineral Interest (3) 5 SC09 Cash for Fractional Shares

Yrs Code Description 5 SC10 Unexchanged Stock of Successor Corp.

5 MI01 Net Revenue Interest 5 SC11 Other Certificates of Ownership

5 MI02 Royalties 5 SC12 Underlying Shares or Other Outstanding Certificates

5 MI03 Overriding Royalties 5 SC13 Funds for Liquidation/Redemption of Unsurrendered

5 MI04 Production Payments Stocks or Bonds

5 MI05 Working Interest 5 SC14 Debentures

5 MI06 Bonuses 5 SC15 US Government Securities

5 MI07 Delay Rentals 5 SC16 Mutual Fund Shares

5 MI08 Shut-in Royalties 5 SC17 Warrants (Rights)

5 MI09 Minimum Royalties 5 SC18 Matured Bond Principal

5 MI99 Aggregate Mineral Interests (Under $50) 5 SC20 Credit Balances

5 SC21 Bearer Bond Interest

Misc. Checks & Intangible Personal Property (4) 5 SC22 Bearer Bond Principal

Yrs Code Description 5 SC99 Aggregate Security Related Cash (Under $50)

1 MS01 Wages, Payroll, Salary

1 MS02 Commissions Trust Investment & Escrow Accounts (9)

5 MS03 Workers Compensation Benefits Yrs Code Description

5 MS04 Payments for Goods & Services 5 TR01 Paying Agent Accounts

3 MS05 Customer Overpayments 5 TR02 Undelivered or Uncashed Dividends

5 MS06 Unidentified Remittances 5 TR03 Funds Held in Fiduciary Capacity

3 MS07 Unrefunded Overcharges 5 TR04 Escrow Accounts

5 MS08 Accounts Payable 5 TR05 Trust Vouchers

3 MS09 Credit Balances-Accounts Receivable 5 TR99 Aggregate Trust Property (Under $50)

3 MS10 Discounts Due

3 MS11 Refunds Due Utilities (10)

5 MS13 Unclaimed Loan Collateral Yrs Code Description

3 MS14 Pension & Profit Sharing Plans 1 UT01 Utility Deposits

1 MS15 Dissolution or Liquidation 5 UT02 Membership Fees

5 MS16 Misc. Outstanding Checks 1 UT03 Refunds or Rebates

5 MS17 Misc. Intangible Property 5 UT04 Capital Credit Distributions

5 MS18 Suspense Liabilities 5 UT99 Aggregate Utility Property (Under $50)

5 MS99 Aggregate Misc. Property (Under $50)

Safe Deposit Boxes & Safekeeping (5)

Yrs Code Description

5 SD01 Safe Deposit Box Contents

5 SD02 Other Safekeeping

5 SD03 Other Tangible Property

PROPERTY TYPE CODES & ABANDONMENT PERIODS

instrumentalities has a one (1) year abandonment period

*****IMPORTANT*****

All property held by government entities or

INSTRUCTIONS-HOLDER ANNUAL REPORT OF

UNCLAIMED PROPERTY TRANSMITTAL (AOS/UP1)

Unless submitting your report online, you must complete and file form AOS/UP1,

Holder Annual Report of Unclaimed Property Transmittal. If there are no

unclaimed funds to report (negative report), then that is the only form that you

need to file.

1. Enter your organization’s basic information, including name and mailing

address.

2. Enter all other information requested on AOS/UP1, including the name,

telephone number, fax number, and e-mail address of the contact person. The

contact person should be the individual who would be able to answer any

questions concerning the report.

3. Answer the due diligence question. Law requires you to perform due diligence

60 to 120 days before filing your report. See pages 16 and 17 for sample due

diligence letters.

4. Indicate which type of report you are filing. Annual: Your regular report due

each year. Negative: No unclaimed funds to report. Supplemental: An additional

report filed to supplement a regular report that you’ve already submitted.

5. Indicate the method of reporting you are using to file your report. Diskette or

CD-ROM reporting (NAUPA electronic reporting) is required for holders

reporting more than 100 records, but can be used for reports of any size. For

NAUPA text file formatting guidelines, please go to our website at

www.auditorjimwood.org/pdf/naupa-revised-standard.pdf. Your diskette or CD-

ROM must be accompanied by a completed AOS/UP1 form.

6. Complete the summary box. Enter the totals from AOS/UP2 cash and AOS/UP3

mineral proceeds. Total these two amounts and attach your check in that total

amount to the front of the form. Enter the totals from AOS/UP4 and AOS/UP5 on

the appropriate lines for shares and safe deposit boxes. Do not enter the value of

shares.

7. An authorized representative MUST sign and date the certification at the bottom

of AOS/UP1.

Regular mail: Special delivery requiring physical address:

Auditor of State Auditor of State

Unclaimed Property Division Unclaimed Property Division

P.O. Box 251906 1401 West Capitol Avenue Suite 325

Little Rock, AR 72225-1906 Little Rock, AR 72201

This transmittal form must accompany your annual report regardless of whether you are filing on paper, diskette, or CD-ROM. If

your report does not meet the specifications set by the Division, it will be returned to you. Holders reporting for multiple entities

under a single entity name (consolidated report) must attach a detail of the entities included in the report.

Holder Name Federal Employer ID # (Tax ID #)

Address State of Incorporation

City, State, Zip Define Your Primary Business Activity

Did you exercise due diligence this year? Type of Report: Method of Reporting:

Yes No Annual Diskette or CD-ROM

Supplemental Paper

Negative Do not mix media types for a single report

Reporting requirements: You must report and remit all property in your custody that belongs to

someone else and has gone unclaimed.

Total # of safe deposit boxes reported on AOS/UP5 A.______________________

Total # of shares reported on AOS/UP4

Physical

DTC

B.______________________

Total mineral proceeds reported on AOS/UP3 C.$_____________________

Total cash reported on AOS/UP2 D.$_____________________

CERTIFICATION: I declare, under penalties imposed by Act 850 of 1999 that I have examined this report, and to

the best of my knowledge it is true and complete and I have the authority to so certify.

Contact Person (Please Print)

Tel (______)_______________ Fax (______)________________

E-Mail________________________________________________

Authorizing Signature Title Date

PROPERTY TRANSMITTAL (AOS/UP1)

*****IMPORTANT*****

YOUR REPORT MUST BE DELIVERED TO OUR OFFICE BY OCTOBER 31 (APRIL 30 FOR LIFE INSURANCE COMPANIES). CALCULATE

ABANDONMENT AS OF JUNE 30 OF THE CURRENT YEAR (PREVIOUS CALLENDAR YEAR END FOR LIFE INSURANCE COMPANIES).

ARKANSAS REPORT OF UNCLAIMED

INSTRUCTIONS-LIST OF OWNERS OF

UNCLAIMED FUNDS (AOS/UP2)

This form is used to report individual cash and cash-related items of unclaimed funds,

stock dividends, and bond funds. If applicable, also or instead complete and return

AOS/UP3, AOS/UP4, and AOS/UP5. Mineral proceeds should be reported separately on

AOS/UP3. If the form provided is not large enough for all cash listings, make a copy of the

blank form before using it or attach a computer printout which includes all of the required

information.

1. Enter the full name of each owner of property valued at $50.00 ($25.00 preferred) or

more. For an owner who is an individual, list the last name, insert a comma, insert a space,

list the full first name, insert a space, and list the middle initial. Please follow the name with

any identifiers such as Jr. or Sr. if applicable. Example:

Smith, James R Jr

Punctuation should consist only of a comma between the last and first names. List

corporation, partnership, association, and trade names exactly as adopted. Where there are

two or more owners of an item, list each owner on a separate line. List the primary owner

first along with the total unclaimed funds for all owners. List the remaining owners along

with $0.00 in the “Amount Reported” column. Example:

Smith, James R Jr $725.00

Smith, Betty S $0.00

2. List the last known address of the owner, beneficiary, payee, or trustee as shown in your

records, even if mail has been returned from that address. If the address is unknown, mark

it as “unknown”. Do not abbreviate city names. Use standard post office abbreviations for

state names.

3. Enter the “Relationship Code” which best describes the owner’s relationship to the funds

and, when there are two or more owners of an item, their relationship to one another. See

P.3 for a list of relationship codes.

4. Please list the owner’s social security number or tax ID number if you have it. Other than

the owner’s name, this is the most important information you can furnish to us. The

Division holds all social security numbers in strictest confidence.

5. Enter the property type code that corresponds to the type of funds you are reporting. See

P.4 for a list of property type codes.

6. Enter the account number or other identifying number for the unclaimed funds you are

reporting. (Example: owner account number, check number, policy number, etc.)

INSTRUCTIONS CONTINUED ON NEXT PAGE

INSTRUCTIONS (AOS/UP2) CONTINUED

7. Enter the date of last transaction such as the last deposit or withdrawal made by the

owner. It may also be the date of the check, or the date the property became payable,

demandable, or distributable. If payable on demand, the date the instrument was issued

should be used. For automatic rollover, use the date following the first maturity.

8. Enter the amount, including interest, dividends, payment of principal, or any other sum

held or owned by the owner. For your convenience, statute allows items under $50.00 to be

lumped together into a single “aggregate” amount. The Division, however, prefers to have

only items under $25.00 lumped together as an “aggregate” amount.

9. Enter the page numbers of AOS/UP2 pages consecutively at the top right-hand corners of

all AOS/UP2 pages.

10. Total the “Amount Reported” column on each page of AOS/UP2 and enter the “Grand

Total” on the last page of AOS/UP2 as well as under “Total cash reported” on AOS/UP1.

STATE OF ARKANSAS Page #________ of ________

LIST OF OWNERS OF UNCLAIMED FUNDS (AOS/UP2)

Holder of unclaimed funds:

Name:_______________________________________________ Address:________________________________________________

(For your conveniece, statute allows items under $50.00 ($25.00 preferred) to be lumped together into a single "aggregate" amount-see instructions.)

Owner Name Last Known Address Relation- Social Property Acct. # Date of Amount

Last, First Middle # & Street ship Security # Type Cert. # Last Reported

(List names alphabetically by last name) City, State, Zip Code Tax ID # Code Policy # Transaction

Enter Page Total Here $

(Also enter on AOS/UP1) If last page of report enter Grant Total Here $

INSTRUCTIONS-LIST OF OWNERS OF

UNCLAIMED MINERAL PROCEEDS (AOS/UP3)

This form is used only to report individual cash and cash-related items of

unclaimed mineral proceeds as defined by Arkansas Code §18-28-201(9).

“Mineral proceeds” means amounts payable for the extraction, production, or

sale of minerals, or upon the abandonment of those payments, all payments that

become payable thereafter. The term includes the amounts payable:

A. For the acquisition and retention of a mineral lease, including bonuses,

royalties, compensatory royalties, shut-in royalties, minimum royalties,

and delay rentals.

B. For the extraction, production, or sale of minerals, including net revenue

interests, royalties, overriding royalties, extraction payments, and

production payments; and

C. Under an agreement or option, including a joint operating agreement, unit

agreement, pooling agreement, and farm-out agreement.

1. See Instructions-List of Owners of Unclaimed Funds (AOS/UP2) on P.7 for

answers to most questions concerning completion of this form.

2. Enter the legal description of the property interest. Example:

NW NW Sec 10

T2N R4W Pope Co

(Well or Project Name)

STATE OF ARKANSAS Page #________ of ________

LIST OF OWNERS OF UNCLAIMED MINERAL PROCEEDS (AOS/UP3)

Holder of unclaimed funds:

Name:_______________________________________________ Address:________________________________________________

(For your conveniece, statute allows items under $50.00 ($25.00 preferred) to be lumped together into a single "aggregate" amount-see instructions.)

Owner Name Last Known Address Relation- Social Property Legal Date of Amount

Last, First Middle # & Street ship Security # Type Description Last Reported

(List names alphabetically by last name) City, State, Zip Code Tax ID # Code of Property Transaction

Enter Page Total Here $

(Also enter on AOS/UP1) If last page of report enter Grant Total Here $

INSTRUCTIONS-HOLDER ANNUAL REPORT OF

UNCLAIMED STOCK AND OTHER SECURITIES

(AOS/UP4)

This form is used to report all classes of stock and undeliverable, unexchanged, underlying,

and other securities presumed abandoned. Unclaimed securities should be listed in

alphabetical order by issuer name, including CUSIP number and account number. Cash

dividends, bond interest, and other security-related cash items are to be reported on AOS/UP2.

DO NOT ENTER the market value of unliquidated securities anywhere on this report. See

instructions for AOS/UP2 for information on how to list owners.

1. See Instructions-List of Owners of Unclaimed Funds (AOS/UP2) on P.7 for answers to most

questions concerning completion of this form.

2. IMPORTANT--Please note that we no longer require or accept the liquidation of mutual

funds. See #8 on page 13 for mutual fund delivery instructions.

3. Enter the issuer name and account number, or CUSIP number, for all reported securities. If

more than one issuer is being reported, list the issuers’ names in alphabetical order.

4. Enter the description of the securities you are reporting. Identify the securities reported by

type class, such as common, preferred, or registered bond.

5. Enter the date of last transaction for all reported accounts. Enter the date on which the

property became payable, redeemable, or returnable. For reportable shares from stock

dividends and stock splits provide the date payable. For unexchanged shares of a successor

corporation provide the effective date when shares of the merged/acquired corporation were

exchanged. If the security is an underlying share, enter the issue date of the earliest uncashed

dividend check as the date of the last transaction.

6. Enter the number of shares for each owner listed on your report. Enter the total number of

shares at the bottom of AOS/UP4. The grand total should be entered on the last page of

AOS/UP4 and on AOS/UP1.

7. All securities (other than mutual funds) must be re-registered in the name of the State of

Arkansas, Unclaimed Property Division, Federal Tax ID #71-6006062 and deposited

directly with our custodial agent, Wachovia Securities Inc., Account #8024-9345 as follows:

DTC:

Wachovia Securities Inc. 141 Code 40

FOA-8024-9345 State of Arkansas, Unclaimed Property Division

By Mail:

Regular Delivery: Special Delivery Requiring Physical Address:

Auditor of State Auditor of State

Unclaimed Property Division Unclaimed Property Division

P.O. Box 251906 1401 West Capitol Avenue, Suite 325

Little Rock, AR 72225-1906 Little Rock, AR 72201

INSTRUCTIONS CONTINUED ON NEXT PAGE

INSTRUCTIONS (AOS/UP4) CONTINUED

8. All mutual funds must be re-registered as follows:

DTC (preferred):

Wachovia Securities Inc. 141 Code 40

FOA-6750-9109 State of Arkansas, Unclaimed Property Division

Tax ID #71-6006062

Direct registration (when DTC not possible):

First Clearing, LLC

Attn: Cash Management-WS1030

10700 Wheat First Drive

Glen Allen, VA 23060

Further credit to Acct #6750-9109

Tax ID #71-6006062

ALL SECURITIES DELIVERIES MUST BE CONFIRMED BY FAX OR E-MAIL TO

THE ARKANSAS AUDITOR OF STATE AT (501) 683-4285 OR

[email protected]

STATE OF ARKANSAS Page #______ of _______

LIST OF OWNERS OF UNCLAIMED STOCK AND OTHER SECURITIES (AOS/UP4)

Holder of unclaimed funds:

Name:_______________________________________________ Address:________________________________________________

Owner Name Last Known Address Relation- Social Description Issuer Name Date of #

Last, First Middle # & Street ship Security # of & Account # Last of

(List names alphabetically by last name) City, State, Zip Code Tax ID # Securities or CUSIP # Transaction Shares

Enter Page Total Here #

(Also enter on AOS/UP1) If last page of report enter Grant Total Here #

INSTRUCTIONS-LIST OF OWNERS OF

UNCLAIMED CONTENTS OF SAFE DEPOSIT

BOXES OR OTHER SAFEKEEPING REPOSITORIES

(AOS/UP5)

Every holder maintaining safe deposit boxes or other safekeeping repositories

located in the state of Arkansas must report and remit property in its possession

which constitutes unclaimed property to the Auditor of State. AOS/UP5 is used

to report the owner information and the total number of boxes or repositories

remitted.

1. ***IMPORTANT*** Before delivering safe deposit box or safekeeping

repository contents to us, you MUST request Auditor of State inventory forms by

contacting the Division at 501-682-9174. The actual box/repository contents

MUST be remitted with the Auditor of State inventory forms attached after

March 1. The standard October 31 deadline will still apply to delivery of your

unclaimed property reporting forms.

2. See Instructions-List of Owners of Unclaimed Funds (AOS/UP2) on P.7 for

answers to most questions concerning completion of this form.

3. Enter the box number rented by the owner.

4. Enter the date of expiration or the date the box was drilled and its contents

inventoried.

5. Enter any costs incurred by the holder, if any, including drilling, storage, and

unpaid rental.

6. Enter the number of boxes reported for each owner. Total each page and enter

the grand total on the last page of AOS/UP5 and again on AOS/UP1.

We strongly recommend that safe deposit box/repository contents be delivered by

bonded messenger or by insured mail for receipt at our office between 8:00 AM

and 4:00 PM, Monday through Friday, excluding holidays.

STATE OF ARKANSAS Page #________ of ________

LIST OF OWNERS OF UNCLAIMED CONTENTS OF SAFE DEPOSIT BOXES

OR OTHER SAFEKEEPING REPOSITORIES (AOS/UP5)

Holder of unclaimed funds:

Name:_______________________________________________ Address:________________________________________________

(NOTE: In addition to filing this form by October 31, a completed Auditor of State Inventory Form must be attached to each owner's contents when remitted after March 31.)

Owner Name Last Known Address Relation- Social Property Safe Fees Number

Last, First Middle # & Street ship Security # Type Deposit Paid by of

(List names alphabetically by last name) City, State, Zip Code Tax ID # Code Box # Holder Boxes

Enter Page Total Here #

(Also enter on AOS/UP1) If last page of report enter Grant Total Here #

SAMPLE

DUE DILIGENCE LETTER

To: ___________________________ Date:_______________

_______________________________

Re: Disposition of Outstanding Check

Our records indicate that the following check issued to you is still outstanding:

Check # Date Issued Amount

Please indicate the disposition of the check on the bottom of this form and return it to

us within ____ days.

Disposition of check:

___ I cashed the above-referenced check. Provide date cashed, if known: ___/___/___

___ I am holding the above-referenced check for the following reason:

________________________________________________________________________

___ I received the above-referenced check, but it has been lost or destroyed. Please

issue a replacement check.

___ I did not receive the above-referenced check. Please issue a replacement check.

___ Other, explain:

________________________________________________________________________

Please sign here:_______________________________

Address:________________________________________________________________

SAMPLE

DUE DILIGENCE LETTER

HOLDER NAME & ADDRESS

CUSTOMER NAME

CUSTOMER ADDRESS

CUSTOMER CITY, STATE, & ZIP

It is the policy of (HOLDER) to review and update our account records periodically.

Our records of your savings/checking account number 123456 indicate no transactions

as of (LAST ACTIVITY DATE) for (REPORT YEAR). Your account needs to be

brought current. State law requires us to turn this account over to the state if the

account is truly abandoned. To prevent us from turning your account over to the state’s

unclaimed property office, please check the appropriate box, sign in the space provided

below, and return this to us as soon as possible.

___ The above-referenced address information is correct for the account and I am

aware of the account.

___ Please change the account holder’s name and/or address to read as follows:

____________________________________

___ I wish to close this account. Please send a check for the closeout amount to the

following address:

____________________________________

Signature: Date:

Your assistance is appreciated. Please contact our office if you have any questions.

Sincerely,

YOUR BANK OFFICER