Free 53-105 - Texas


File Size: 40.2 kB
Pages: 1
Date: September 14, 2000
File Format: PDF
State: Texas
Category: Tax Forms
Author: Steve
Word Count: 385 Words, 2,572 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.window.state.tx.us/taxinfo/taxforms/53-105.pdf

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Preview 53-105
53-105 (Rev. 6-97/2)

COMPTROLLER OF PUBLIC ACCOUNTS UNCLAIMED PROPERTY HOLDER REPORTING SECTION PAGE _____ OF _____
Federal Employer Identification Number (FEIN)

TEXAS REPORT OF UNCLAIMED PROPERTY
Holder name

Item no.

Property type

Property description

Owner last name

First name/middle initial

Title

Mailing address

City, state, ZIP code

Country, if not U.S.A. Amount remitted to Comptroller

Date of last contact

OR
FROM

Periodic payments TO

Owner Social Security Number (SSN)

$
Additional owner title Additional owner SSN

COMPLETE ADDITIONAL OWNER BOXES (BELOW) IF THERE IS MORE THAN ONE OWNER FOR THIS PROPERTY.
Additional owner last name First name/middle initial

Additional owner last name

First name/middle initial

Additional owner title

Additional owner SSN

Item no.

Property type

Property description

Owner last name

First name/middle initial

Title

Mailing address

City, state, ZIP code

Country, if not U.S.A. Amount remitted to Comptroller

Date of last contact

OR
FROM

Periodic payments TO

Owner Social Security Number (SSN)

$
Additional owner title Additional owner SSN

COMPLETE ADDITIONAL OWNER BOXES (BELOW) IF THERE IS MORE THAN ONE OWNER FOR THIS PROPERTY.
Additional owner last name First name/middle initial

Additional owner last name

First name/middle initial

Additional owner title

Additional owner SSN

Item no.

Property type

Property description

Owner last name

First name/middle initial

Title

Mailing address

City, state, ZIP code

Country, if not U.S.A. Amount remitted to Comptroller

Date of last contact

OR
FROM

Periodic payments TO

Owner Social Security Number (SSN)

$
Additional owner title Additional owner SSN

COMPLETE ADDITIONAL OWNER BOXES (BELOW) IF THERE IS MORE THAN ONE OWNER FOR THIS PROPERTY.
Additional owner last name First name/middle initial

Additional owner last name

First name/middle initial

Additional owner title

Additional owner SSN

Item no.

Property type

Property description

Owner last name

First name/middle initial

Title

Mailing address

City, state, ZIP code

Country, if not U.S.A. Amount remitted to Comptroller

Date of last contact

OR
FROM

Periodic payments TO

Owner Social Security Number (SSN)

$
Additional owner title Additional owner SSN

COMPLETE ADDITIONAL OWNER BOXES (BELOW) IF THERE IS MORE THAN ONE OWNER FOR THIS PROPERTY.
Additional owner last name First name/middle initial

Additional owner last name

First name/middle initial

Additional owner title

Additional owner SSN

IF LAST PAGE, ENTER GRAND TOTAL REMITTED

$

PAGE TOTAL

$