The Virginia Unclaimed Property form is a document used by businesses to report unclaimed assets to the state. These assets can include cash, securities, and tangible property that has been abandoned or forgotten. Completing this form is essential for compliance with Virginia law and helps ensure that rightful owners can reclaim their property.
The Virginia Unclaimed Property form serves as a crucial tool for businesses and individuals to report unclaimed assets that may belong to others. This form is administered by the Commonwealth of Virginia’s Department of the Treasury and is essential for ensuring that unclaimed property is returned to its rightful owners. It requires detailed information about the holder, including the business entity's name, address, and federal employer identification number. Additionally, it prompts the reporting entity to provide specifics about the unclaimed property, such as cash, securities, and tangible items. The form also includes sections for due diligence dates and the types of media attached to the report. Importantly, it mandates that an authorized representative certifies the accuracy of the report, highlighting the legal obligation to comply with Virginia's unclaimed property laws. Failure to report and remit as required can result in penalties and interest, underscoring the form's significance. By completing this form accurately, holders can help ensure that unclaimed assets are managed responsibly and returned to those who rightfully own them.
COMMONWEALTH OF VIRGINIA DEPARTMENT OF THE TREASURY Division of Unclaimed Property
P O Box 2478 Richmond, VA 23218 PHONE (804) 225-2393 FAX (804) 786-4653
TOLL FREE 1-800-468-1088
For State Use Only
CHECK AMOUNT ________
CHECK # _______________
DEPOSIT DATE _________
INITIALS _______________
INTEREST PAYMENT AMOUNT $________________________
Holder Name
Holder Number
Address
City, State Zip Code
AP1 FORM FOR REPORT OF UNCLAIMED PROPERTY
1. Contact person:
2.
If the address above is incorrect, please correct here:
Name:___________________________________
_______________________________________________
Title: ________________________________________
Department: __________________________________
____________________________________________________
Telephone Number: ____________________________
3.
Please provide
FAX Number: _________________________________
e-mail address ________________________________________
ABOUT THIS BUSINESS ENTITY:
4.Federal Employer Identification Number _________________5. Standard Industry Code _________________________________
6.
State of Incorporation (or locality where business license is filed if not incorporated) ______________________________________
7.Date of Incorporation ________________________________8. Primary Business Activity ________________________________
9.Annual Gross Income $ ________________ Assets $ _________________________ # of Employees_______________________
ABOUT THIS REPORT:
10.Date(s) Due Diligence was Performed _____________________________
11.
This report is for Report Year _________ and the type of report is
REGULAR
AUDIT
NEGATIVE
OTHER ___________
12.
This report has the following media attached to report the property details:
REPORT UPLOADED TO WEBSITE
DISKETTE/CD
HARD COPY-PAPER, CONSISTING OF __________PAGES
13.
This is the first time this business entity has filed an Unclaimed Property Report:
YES
NO
14.Property types on this report include: CASH SECURITIES MUTUAL FUNDS TANGIBLE PROPERTY
IMPORTANT NOTICE: Your remittance must accompany this report and an authorized representative of your business must complete the certification that follows. Please complete the summary information on the reverse of this page, and mail your report and remittance to the address at the top of this form. Pursuant to §55-210.26:1 of the Code of Virginia, interest and penalties may be imposed for failure to report and remit as required.
I, _______________________________________________, CERTIFY THAT I HAVE CAUSED TO BE PREPARED AND HAVE EXAMINED THIS
REPORT AS TO PROPERTY PRESUMED ABANDONED UNDER THE VIRGINIA UNCLAIMED PROPERTY LAW FOR THE YEAR ENDING AS STATED, THAT I AM DULY AUTHORIZED TO EXECUTE THIS VERIFICATION BY THE HOLDER AND BY LAW AND THAT I BELIEVE THAT SAID REPORT IS TRUE, CORRECT, AND COMPLETE AS OF SAID DATE, EXCEPTING FOR SUCH PROPERTY AS HAS SINCE CEASED TO BE ABANDONED. THIS REPORT TOTALS # _______PROPERTIES FOR $______________________ AND #_________________ SHARES.
SIGNATURE _____________________________________________________________
TITLE __________________________________________________________________ DATE ________________________________
CASH PROPERTY
ACCOUNT BALANCES DUE
AC01 CHECKING ACCOUNTS
AC02 SAVINGS ACCOUNTS
AC03 MATURED CD OR SAVINGS CERTIFICATE AC04 CHRISTMAS CLUB FUNDS
AC05 MONEY ON DEPOSIT TO SECURE FUND AC06 SECURITY DEPOSIT
AC07 UNIDENTIFIED DEPOSITS
AC08 SUSPENSE ACCOUNTS AC09 SHARE ACCOUNTS
AC21 MISCELLANEOUS DEPOSITS
AC99 AGGREGATE ACCOUNT BALANCES <$100
UNCASHED CHECKS
CK01 CASHIER’S CHECKS
CK02 CERTIFIED CHECKS
CK03 REGISTERED CHECKS
CK04 TREASURER’S CHECKS CK05 DRAFTS
CK06 WARRANTS CK07 MONEY ORDERS CK08 TRAVELER’S CHECKS
CK09 FOREIGN EXCHANGE CHECKS CK10 EXPENSE CHECKS
CK11 PENSION CHECKS
CK12 CREDIT CHECKS OR MEMOS CK13 VENDOR CHECKS
CK14 CHECKS WRITTEN OFF TO INCOME CK15 OTHER OUTSTANDING OFFICIAL CHECKS CK16 CD INTEREST CHECKS
CK99 AGGREGATE UNCASHED CHECKS <$100
MISCELLANEOUS CHECKS
MS01 WAGES, PAYROLL, SALARY MS02 COMMISSIONS
MS03 WORKERS’ COMPENSATION BENEFITS MS04 PAYMENT FOR GOODS & SERVICES MS05 CUSTOMER OVERPAYMENTS
MS06 UNIDENTIFIED REMITTANCES
MS07 UNREFUNDED OVERCHARGES MS08 ACCOUNTS PAYABLE
MS09 CREDIT BALANCES – A/R MS10 DISCOUNTS DUE MS11 REFUNDS DUE
MS12 UNREDEEMED GIFT CERTIFICATES MS13 UNCLAIMED LOAN COLLATERAL
MS14 PENSION & PROFIT SHARING PLANS (IRA , KEOGH) MS15 DISSOLUTION OR LIQUIDATION
MS16 MISC OUTSTANDING CHECKS
MS17 MISC INTANGIBLE PROPERTY MS18 SUSPENSE LIABILITIES MS19 OTHER CASH
MS20 Rental Property Income
MS99 AGGREGATE MISC PROPERTY <$100
COURT & LOCALITY FUNDS
CT01 ESCROW FUNDS
CT02 CONDEMNATION AWARDS
CT03 MISSING HEIRS’ FUNDS
CT04 SUSPENSE ACCOUNTS
CT05 OTHER COURT DEPOSITS
CT07 EVIDENCE MONEY
CT08 GENERAL RECEIVER ACCOUNTS CT09 COURT ORDERED REFUNDS
CT10 PERSONAL PROPERTY TAX OVERPAYMENT CT11 REAL ESTATE TAX OVERPAYMENT
CT12 COURT HELD ACCOUNTS CT13 BONDS
CT14 ESTATE ACCOUNTS CT15 LITIGATIONS CT16 RESTITUTIONS
CT99 AGGREGATE COURT DEPOSITS <$100
INSURANCE
IN01 INDIVIDUAL POLICY BENEFITS OR CLAIMS PD
IN02 GROUP POLICY BENEFITS OR CLAIMS PAID
IN03 PROCEEDS DUE BENEFICIARIES
IN04 PROCEEDS FROM MATURED POLICIES, ENDOWMENTS
IN05 PREMIUM REFUNDS
IN06 UNIDENTIFIED REMITTANCES
IN07 OTHER AMOUNTS DUE UNDER POLICY TERMS
IN08 AGENT CREDIT BALANCES
IN09 ANNUITIES
IN10 DEMUTUALIZATION CASH
IN11 DEMUTUALIZATION SECURITIES
IN99 AGGREGATE INSURANCE PROPERTY <$100
TRUST, INVESTMENT AND ESCROW
ACCOUNTS
TR01 PAYING AGENT ACCOUNTS
TR02 UNDELIVERED OR UNCASHED DIVIDENDS TR03 FUNDS HELD IN FIDUCIARY CAPACITY TR04 ESCROW ACCOUNTS
TR05 TRUST VOUCHERS
TR06 ENDOWMENT FUNDS
TR99 AGGREGATE TRUST PROPERTY <$100
UTILITIES
UT01 UTILITY DEPOSITS
UT02 MEMBERSHIP FEES UT03 REFUNDS OR REBATES
UT04 CAPITAL CREDIT DISTRIBUTIONS UT99 AGGREGATE UTILITY PROPERTY <$100
MINERAL PROCEEDS & MINERAL
INTERESTS
Mi01 NET REVENUE INTEREST MI02 ROYALTIES
MI03 OVERRIDING ROYALTIES
MI04 PRODUCTION PAYMENTS MI05 WORKING INTEREST MI06 BONUSES
MI07 DELAY RENTALS MI08 SHUT-IN ROYALTIES MI09 MINIMUM ROYALTIES
MI99 AGGREGATE MINERAL INTERESTS <$100
CASH PROPERTY SUMMARY:
TOTAL CASH REMITTED:_______________________
TOTAL # OF ITEMS: ___________________________
TANGIBLE PROPERTY
SAFE DEPOSIT BOXES & SAFEKEEPING
SD01 SAFE DEPOSIT BOX CONTENTS
SD02 OTHER SAFEKEEPING
SD03 OTHER TANGIBLE PROPERTY
TANGIBLE PROPERTY SUMMARY:
TOTAL ITEM COUNT:________________________
TOTAL # OF OWNERS: ______________________
SECURITY PROPERTY
SECURITIES
SC01 DIVIDENDS
SC02 INTEREST (BOND COUPONS) SC03 PRINCIPAL PAYMENTS SC04 EQUITY PAYMENTS
SC05 PROFITS
SC06 FUNDS PAID TO PURCHASE SHARES SC07 FUNDS FOR STOCKS AND BONDS SC08 SHARES OF STOCK (RETURNED BY POST
OFFICE)
SC09 CASH FOR FRACTIONAL SHARES
SC10 UNEXCHANGED STOCK OF SUCCESSOR CORP SC11 OTHER CERTIFICATES OF OWNERSHIP SC12 UNDERLYING SHARES OR OTHER
STANDING CERTIFICATES
SC13 FUNDS FOR LIQUIDATION/REDEMPTION OF UNSURRENDERED STOCK OR BONDS
SC14 DEBENTURES
SC15 US GOVT SECURITIES
SC16 MUTUAL FUND SHARES
SC17 WARRANTS (RIGHTS)
SC18 MATURED BOND PRINCIPAL SC19 DIVIDEND REINVESTMENT PLANS SC20 CREDIT BALANCES
SC21 LIQUIDATED MUTUAL FUND SHARES SC97 MUTUAL FUND IRA/RETIREMENT ACCTS SC99 AGGREGATE SECURITY RELATED CASH <$100
SECURITY PROPERTY SUMMARY: TOTAL SHARES REMITTED:__________________
TOTAL # OF ITEMS: _________________________
MISCELLANEOUS
ZZZZ PROPERTIES NOT IDENTIFIED ABOVE
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