Form 4305 – Fill Out and Use This PDF

Michigan Department of Treasury 4305 (Rev. 01-11)

Attestation of Compliance with Unclaimed Property Reporting

(No Unclaimed Property to Report)

An authorized representative of an entity having no unclaimed property reportable under the Uniform Unclaimed Property Act (1995 PA 29, Michigan Compiled Law 567.221-567.265) must complete this form and file it with the Michigan Department of Treasury.

By my signature below, I attest to the following:

I am an authorized representative of the entity named below.

I am aware of the unclaimed property types and dormancy periods under the Uniform Unclaimed Property Act.

The entity named below has no unclaimed property in its possession that has reached its legal dormancy according to the Act.

I acknowledge that Section 31(2) of the Uniform Unclaimed Property Act provides authority to the State Treasurer to conduct an examination of the company's books and records.

I am aware that an unclaimed property examination will cover up to the last ten reportable years and result in assessment of penalty and interest.

Entity Name	Federal Employer Identification Number		TR or ME Number (if applicable)
Address
City, State, ZIP Code		Primary Business Activity
Authorized Representative (print or type)		Title of Authorized Representative
E-mail Address of Authorized Representative		Telephone Number of Authorized Representative
Signature of Authorized Representative		Date

Visit the Michigan Department of Treasury Web site at www.michigan.gov/unclaimedproperty for more information on the Uniform Unclaimed Property Act. If you have questions, contact the Unclaimed Property Division at (517) 636-6940.

Return completed form to:	Unclaimed Property Division
	Michigan Department of Treasury
	P.O. Box 30756
	Lansing, MI 48909