Line 15: renaissance zone deduction. to be eligible you must meet all the following requirements: be a permanent resident of a renaissance zone for at least 183 days. must not be delinquent for any state or local taxes abated by the renaissance...
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Holder request for reimbursement important north dakota state land department unclaimed property division po box 5523 bismarck nd 58506-5523 (701) 328-2800 sfn 17 (01/00) property being requested for refund was sent to nd unclaimed property...
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Ap-5 instructions instructions for holder request for reimbursement purpose: a holder of abandoned and unclaimed property must complete this form to seek reimbursement from the treasury department for funds or shares which were paid by the holder...
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14423-0908 standard prescription reimbursement claim form important! * always allow up to 30 days from the time you send this form until the time you receive the response to allow for mail time plus claims processing. * keep a copy of all...
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*d3$ers*1. please print or type clearly. 2. this application is for pension plan refunds only. to request a distribution or rollover of your 401(k) plan, access your account at .gabreeze.ga.gov or call 1-877-342-7339. 2. send this form to your...
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Revised 2005 holder request for reimbursement state of report year report total part i holder information holder name address city state zip tax id# contact name contact telephone no. contact fax no. part ii claim information property code acct....
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State of colorado - treasurers office unclaimed property division 1580 logan st ste 500, denver, co 80203-1941 303-866-6070 greatcopayback state.co.us http://.greatcopayback.com holder request for reimbursement standardized holder claim form for...
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Print form form also available at naupa s web site .unclaimed.org holder request for reimbursement state of report year part i holder information address holder name tax id# contact part ii claim information property code city state zip contact...
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Commonwealth of pennsylvania unclaimed property p.o. box 8500-53473 ap-2 form philadelphia, pa 19178 account or check number last activity date owner name(s) and relationship code property code/description social security no. (optional) amount due...
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Holder request for reimbursement state of connecticut office of the state treasurer unclaimed property division 55 elm street, 5th floor hartford, ct 06106 for funds paid to the state on date/amount of holder report: month: date: year: amount:...
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