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Vermont State Treasurer’s Office – Unclaimed Property Division

109 State Street, Montpelier, Vermont 05609-6200


Phone: 802-828-2407 Fax: 802-828-2772

INVENTORY OF UNCLAIMED SAFE DEPOSIT BOX CONTENTS


DO NOT ATTACH TO CONTENTS – ATTACH TO COVER SHEET

1. Holder Name:______________________________________ Rental and Opening


Charges
2. Branch Where Property Was Held_____________________ _______________
_______________
3. Period Covered:________to_______Page________of______ Total __________

4. Safe Deposit Box Number:____________________________

5. Date of Abandonment________________________________

6. Owner Information

Last Name _____________________ First ____________________Middle__________

Mailing Address:__________________________________________________________
___________________________________________________________________________

Social Security Number:_________________________________ __________________

7. Itemized Description of Contents (one Item Per Line or Attach Itemized List)

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