Free 53-117 Unclaimed Property Holder Claim Supplement - Texas


File Size: 361.5 kB
Pages: 1
Date: July 16, 2005
File Format: PDF
State: Texas
Category: Tax Forms
Author: Steve Mittel
Word Count: 149 Words, 1,067 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.window.state.tx.us/taxinfo/taxforms/53-117.pdf

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Comptroller of Public Accounts Form 53-117 (Rev. 7-01/1)

TEXAS UNCLAIMED PROPERTY

HOLDER CLAIM FORM SUPPLEMENT
(to be used with the Holder Refund Request Form or the Holder Reimbursement Request Form) HOLDER INFORMATION
Holder Name: Tax ID Number:

PROPERTY INFORMATION
Report Year: Report Amount: Property Type: Aggregate: Yes No Property Amount: Claim Amount: No. of Shares:

Owner Name as Indicated on Report:

Owner Address:

Property Description:

PROPERTY INFORMATION
Report Year: Report Amount: Property Type: Aggregate: Yes No Property Amount: Claim Amount: No. of Shares:

Owner Name as Indicated on Report:

Owner Address:

Property Description:

PROPERTY INFORMATION
Report Year: Report Amount: Property Type: Aggregate: Yes No Property Amount: Claim Amount: No. of Shares:

Owner Name as Indicated on Report:

Owner Address:

Property Description:

PROPERTY INFORMATION
Report Year: Report Amount: Property Type: Aggregate: Yes No Property Amount: Claim Amount: No. of Shares:

Owner Name as Indicated on Report:

Owner Address:

Property Description: