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Commonwealth of Kentucky
Unclaimed Property Claim Form Request
Note: This is NOT a claimform. An official claimform MUST be requested.
Ifyou wish to seek additional information about an account, please call 1-800-465-4722.
Todd Hollenbach, State Treasurer
Owner name:Property ID number:
Owners’ date of birth:______________________________________________________________________________
Name of person requesting claim form:
Relationship to reported owner:
(for example: self, spouse, executor/administrator, parent, POA, heir, etc.)
Address: _____________________________________________________________________________________
| Day time phone #: ( | ) | -________________ E-mail address: | 
Please give the last 4 digits of the owner’s Social Security number or FEIN, if a business:
Please answer the questions below to assist us in verifying information on our database to assure that you are entitled to claim thesefunds. Please circle the correct response(s).
| 1. Did the reported owner ever live or receive mail at the | (Please circle) | 
| address shown on the search page? | Yes | No | 
| 2. Is the reported owner deceased? | Yes | No | 
| If yes, date: |   |   | 
3.Name of the administrator/executor of the reported owners’ estate?
Please mail this form to:
Unclaimed Property Division, 1050 US Hwy 127 South, Suite 100, Frankfort, KY 40601
(800-465-4722 / FAX: 502-564-4200)