Form Ac2709 PDF Details

Understanding the AC2709 form is essential for businesses when dealing with unclaimed funds in New York State. Distributed by the New York State Comptroller's Office of Unclaimed Funds, this detailed form serves as a comprehensive checklist and verification tool to ensure accurate reporting of abandoned or unclaimed property. Whether it's dormant accounts, undeposited checks, insurance proceeds, or other unclaimed assets, the AC2709 form covers a broad range of property types with specific periods of dormancy. Businesses are required to thoroughly check and report on account balances, negotiable instruments, investments, refunds, and even funds owed by courts and government units among others, providing detailed amounts and relevant information for each category. Also included are sections for the reporting organization's details, authorization confirmations, and a mandatory certification by a duly authorized officer of the organization, attesting to the completeness and accuracy of the report. The form not only facilitates compliance with state regulations but also plays a crucial role in the process of returning lost or forgotten assets to their rightful owners, promoting financial integrity and responsibility within the corporate community.

QuestionAnswer
Form NameForm Ac2709
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesUndelivered, ac2709 form, form ac2709 fillable, New_York

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AC2709 (Rev. 05/11)

New York State Comptroller

 

OFFICE OF UNCLAIMED FUNDS

 

110 State Street, 8TH Floor

 

Albany, NY 12236-0001

 

VERIFICATION AND CHECKLIST FOR UNCLAIMED PROPERTY

Reporting Organization:

__________________________________________________

(name of business)

__________________________________________________

(area or department, e.g., Corp Trust Division)

__________________________________________________

(street address)

__________________________________________________

(street address)

__________________________________________________

(city, state, zip code)

__________________________________________________

(service bureau, if used)

__________________________________________________

(service bureau contact name)

__________________________________________________

(service bureau contact phone)

Verification for Period Ended ____________ , 20 __________

State of Incorporation

_______________________________

Date of Incorporation

_______________________________

Are You Authorized To Do Business in NYS?

____________

FEDERAL EMPL ID NO:

______________________________

 

 

Contact Person

______________________________________

Contact Title

______________________________________

Contact Phone

(_____)________________________________

Contact Fax

(_____)________________________________

Address

______________________________________

 

______________________________________

 

______________________________________

 

______________________________________

Email Address

______________________________________

 

 

 

 

I certify that I am a duly authorized officer of the above named organization. To the best of my knowledge and belief this report is a true and complete statement of all abandoned property held by, or owing by, this organization as of the report period end date.

Payment Type: Electronic

Check

Securities

□

□

□

_____________________________________________

Signature

Totals: Cash

_______________________________

Issues

_______________________________

Shares

_______________________________

RESERVED FOR USE OF STATE COMPTROLLER

Amount Received

Date Received

Ack. Number

Media Type

Class

Report Sequence

Year

Comments

Be sure to complete the "checklist" sheet, indicating types and amounts of property being reported. Also, please verify that the property type(s) used on this form are the same as the ones used in your detailed Report of Abandoned Property. Detailed instructions for completing this form are in the Handbook for Reporters of Unclaimed Funds.

1.

ACCOUNT BALANCES

Dormancy

Cash

Shares

 

 

Period

 

 

A.

Demand Deposit Account(s)

3 yrs

1A. $ ___________________

 

B.Savings Accounts (includes Club Accounts, Security Deposits &

 

Retirement Accounts)

3 yrs

1B.

$ ___________________

C.

Time Deposit Accounts

3 yrs

1C.

$ ___________________

D.

Money on Deposits to Security Funds (if separate from A & B)

3 yrs

1D.

$ ___________________

E.

Unidentified Deposits (if separate from A & B) & Suspense Accounts

3 yrs

1E.

$ ___________________

F.

Escrow Funds (Mortgages, Performance Guarantee, Surety Bonds, etc.)

3 yrs

1F.

$ ___________________

G.Credit Balances Arising from Loans (includes Liquidated Mortgages,

 

Consumer Loans, Remainder of Collateral Amounts, etc.)

3 yrs

1G.

$ ___________________

H.

Credit Balances; Consumer Credit Accounts

3 yrs

1H.

$ ___________________

I.Credit Balances in Trading & Investment Accounts with Trusts, Brokers,

 

Investment Firms, etc. (Including O/S checks issued to customers)

3 yrs

1I.

$ ___________________

J.

Credit Balances or Cash Due Renters of Safe Deposit Boxes

3 yrs

1J.

$ ___________________

2.NEGOTIABLE INSTRUMENTS

A.

Certified Checks

3 yrs

2A.

$

___________________

B.

Cashier, Teller Checks

3 yrs

2B.

$

___________________

C.

Bank Money Orders

3 yrs

2C.

$

___________________

D.

Treasurer & Registered Checks

3 yrs

2D.

$

___________________

E.

Drafts & Bank Traveler’s Checks

3 yrs

2E.

$

___________________

F.

Warrants

3 yrs

2F.

$

___________________

G.

Outstanding Checks Issued to Vendors (Accounts Payable)

3 yrs

2G.

$

___________________

H.

Travelers Checks (non-bank)

15 yrs

2H.

$

___________________

I.

Licensed Money Transmitter Receipts & Money Orders (non-bank)

5 yrs

2I.

$

___________________

J

State Checks

1 yr

2J.

$

___________________

3.PAYING AGENTS, FIDUCIARY, MUTUAL FUNDS, AMERICAN DEPOSITORY

RECEIPT ACCOUNTS AND CORPORATION DISBURSING DIRECTLY TO THEIR OWN SHAREHOLDERS

A.

Cash Dividends (other than ADR)

3 yrs

3A.

$ ___________________

B.

Bond Interest (other than ADR)

3 yrs

3B.

$ ___________________

C.

Stock Dividends (other than ADR)

3 yrs

3C.

$ ___________________ 3P ______________

D.Distributions from Ownership of Interest (other than ADR), includes \ Redemption Values, Warrants, Underlying & Unexchanged Shares &

 

Accrued Dividends

3 yrs

3D.

$ ___________________

3Q ______________

E.

Cash Dividends (ADR)

3 yrs

3E.

$ ___________________

 

F.

Stock Dividends (ADR)

3 yrs

3F.

$ ___________________

3R ______________

G.

Other Distributions Resulting From Ownership of Interest (ADR)

3 yrs

3G.

$ ___________________

3S ______________

H.

Bond Redemption

3 yrs

3H.

$ ___________________

3T ______________

I.

Mutual Fund & Dividend Reinvestment)

3 yrs

3I.

$ ___________________

3U ______________

4.INVESTMENTS, TRADING (BROKER/DEALER) AND BANK TRUST DEPARTMENT ACCOUNTS REPRESENTING DISTRIBUTIONS RECEIVED FOR KNOWN AND UNKNOWN OWNERS

A.

Cash Over Receipts (Dividends & Other)

3 yrs

4A.

$ ___________________

 

B.

Bond Interest Over Receipts

3 yrs

4B.

$ ___________________

 

C.

Stock Over Receipts (Dividends & Other)

3 yrs

4C.

$ ___________________

4P_______________

D.

Other Over Receipts

3 yrs

4D.

$ ___________________

4Q ______________

E.

Unidentified Overages

3 yrs

4E.

$ ___________________

4R ______________

F.

Other Distributions Resulting from Ownership Interest or Debt Obligation

3 yrs

4F.

$ ___________________

4S ______________

5.REFUNDS

A.

Utility Service Deposit

2 yrs

5A.

$ ___________________

B.

Advance Payments for Utility Services Not Furnished

2 yrs

5B.

$ ___________________

C.

Refunds Due on Overcharges by Utility Companies

2 yrs

5C.

$ ___________________

D.

Refunds Due by Insurance Companies

3 yrs

5D.

$ ___________________

E.

Amounts Due for Undelivered Goods and/or Services

3 yrs

5E.

$ ___________________

F.

Rebates

3 yrs

5F.

$ ___________________

6.INSURANCE PROCEEDS

A.

Limiting Age (Superannuated) Contracts

N/A

6A.

$ ___________________

B.

Matured Endowments

3 yrs

6B.

$ ___________________

C.

Death Claims

3 yrs

6C.

$ ___________________

D.

Amounts Due Under Policies of Insurance Other than Life

3 yrs

6D.

$ ___________________

E.

Refunds & Other Amounts Due Under Policy Terms

3 yrs

6E.

$ ___________________

F.

Annuities

3 yrs

6F.

$ ___________________

G .

Retained Asset Accounts, Benefits Access Accounts or similar distribution

 

 

 

 

Accounts

3 yrs

6G.

$ ___________________

7.FUNDS OWING BY COURTS AND GOVERNMENTAL UNITS

A.

Trust Funds

3 yrs

7A.

$ ___________________

B.

Bail Funds

3 yrs

7B.

$ ___________________

C.

Funds for Support of Spouse or Child

3 yrs

7C.

$ ___________________

D.

Condemnation Awards

3 yrs

7D.

$ ___________________

X.

Other

3 yrs

7X.

$ ___________________

8.OTHER AMOUNTS AND SECURITIES

A.

Wages, Payroll, Salaries, Commissions, Pension Payments

3 yrs

8A.

$ ___________________

 

B.

Unredeemed Gift Certificates

5 yrs

8B.

$ ___________________

 

C.

Amounts Owed by Sales & Insurance Finance Companies

3 yrs

8C.

$ ___________________

 

D.

Surplus from Sale of Pledged Property

1 yr

8D.

$ ___________________

 

E.

Lost Property

3 yrs

8E.

$ ___________________

 

F.

Securities Long in Customers’ Trading, Investment, Trust Accounts

3 yrs

8F.

$ ___________________

8P ______________

G.

Securities Held As Transfer Agent

3 yrs

8G.

$ ___________________

8Q ______________

H.

Securities Held in a Vault or Storage Area of a Bank

3 yrs

8H.

$ ___________________

8R ______________

I.

Securities Lost & held by a Safe Deposit Company or Bank

3 yrs

8I.

$ ___________________

8S ______________

J.

Securities Found in a Safe Deposit Box

3 yrs

8J.

$ ___________________

8T ______________

K.

Other Securities Owed

3 yrs

8K.

$ ___________________

8U ______________

X.

Late Filing Interest

 

8X.

$ ___________________

 

Y.

Other Miscellaneous Property

3 yrs

8Y.

$ ___________________

8Z ______________

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