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Commonwealth of Kentucky
Unclaimed Property Claim Form Request
Note: This is NOT a claimform. An official claimform MUST be requested.
Ifyou wish to seek additional information about an account, please call 1-800-465-4722.
Todd Hollenbach, State Treasurer
Owner name:Property ID number:
Owners’ date of birth:______________________________________________________________________________
Name of person requesting claim form:
Relationship to reported owner:
(for example: self, spouse, executor/administrator, parent, POA, heir, etc.)
Address: _____________________________________________________________________________________
Day time phone #: ( |
) |
-________________ E-mail address: |
Please give the last 4 digits of the owner’s Social Security number or FEIN, if a business:
Please answer the questions below to assist us in verifying information on our database to assure that you are entitled to claim thesefunds. Please circle the correct response(s).
1. Did the reported owner ever live or receive mail at the |
(Please circle) |
address shown on the search page? |
Yes |
No |
2. Is the reported owner deceased? |
Yes |
No |
If yes, date: |
|
|
3.Name of the administrator/executor of the reported owners’ estate?
Please mail this form to:
Unclaimed Property Division, 1050 US Hwy 127 South, Suite 100, Frankfort, KY 40601
(800-465-4722 / FAX: 502-564-4200)