Escheatment Information Form

Escheatment Information Form

  • MM slash DD slash YYYY
  • Contact Information

  • Identity Verification

    To confirm the correct person is receiving the proper amount of funds, please enter the last 4 of your social security number and your date of birth.

    This information is kept confidential and is for verification purposes only.
  • Consent to Reissue Earnings

  • Signature capture works with tables and other devices with touch screen.