AC 2686 (1/02)  STATE OF NEW YORK – OFFICE OF THE STATE COMPTROLLER –REPORT OF ABANDONED PROPERTY                                                                                                     Page                       of           
 Do Not Write in This Area  Rec Name of Reporting Organization                  Address of Reporting Organization                                        City           State  Zip               For The Period Ending 
 OUF USE ONLY             No.                                                                                                                                                                                                  ,   20      

                              Owner Last Name (20)             First Name (10)                       M.I. Suffix (3) Account Title (70) 

                           1  Owner Address 1 (30)                              Owner Address 2 (30)                                    Owner City (20)                 State (2)      Zip (9)          Country if Not USA 
         Lot No. 
                              Soc. Sec. No./Empl. ID No.   Property Type (2) Property ID Number (20)                 Date (MMDDYY)      Initial Amount Escheated Amount Removal Indicator (If Applicable, Enter “P” or “R”)   Multiple Owners 
                                                                                                                                                                                  P    Otherwise R                                        
         Reg.                                                                                                                      $                   $                Owner Claimed  Reduced to Zero                        Yes 
                              Description of Security (70)                                                                                               CUSIP Number of Security No. of Shares or Denomination  Method of Transfer 

                              Owner Last Name (20)             First Name (10)                       M.I. Suffix (3) Account Title (70) 

                           2  Owner Address 1 (30)                              Owner Address 2 (30)                                    Owner City (20)                 State (2)      Zip (9)          Country if Not USA 
         Lot No. 
                              Soc. Sec. No./Empl. ID No.   Property Type (2) Property ID Number (20)      Date (MMDDYY)            Initial Amount      Escheated Amount Removal Indicator (If Applicable, Enter “P” or “R”)   Multiple Owners 
                                                                                                                                                                                  P    Otherwise R                            
         Reg.                                                                                                                      $                   $                Owner Claimed  Reduced to Zero                        Yes 
                              Description of Security (70)                                                                                               CUSIP Number of Security No. of Shares or Denomination  Method of Transfer 

                              Owner Last Name (20)             First Name (10)                       M.I. Suffix (3) Account Title (70) 

                           3  Owner Address 1 (30)                              Owner Address 2 (30)                                    Owner City (20)                 State (2)      Zip (9)          Country if Not USA 
         Lot No. 
                              Soc. Sec. No./Empl. ID No.   Property Type (2) Property ID Number (20)                 Date (MMDDYY)      Initial Amount Escheated Amount Removal Indicator (If Applicable, Enter “P” or “R” )  Multiple Owners 
                                                                                                                                                                                  P    Otherwise R                                        
         Reg.                                                                                                                      $                   $                Owner Claimed  Reduced to Zero                        Yes 
                              Description of Security (70)                                                                                               CUSIP Number of Security No. of Shares or Denomination  Method of Transfer 

                              Owner Last Name (20)             First Name (10)                       M.I. Suffix (3) Account Title (70) 

                           4  Owner Address 1 (30)                              Owner Address 2 (30)                                    Owner City (20)                 State (2)      Zip (9)          Country if Not USA 
         Lot No. 
                              Soc. Sec. No./Empl. ID No.   Property Type (2) Property ID Number (20)                 Date (MMDDYY)      Initial Amount Escheated Amount Removal Indicator (If Applicable, Enter “P” or “R”)   Multiple Owners 
                                                                                                                                                                                  P    Otherwise R                                        
         Reg.                                                                                                                      $                   $                Owner Claimed  Reduced to Zero                        Yes 
                              Description of Security (70)                                                                                               CUSIP Number of Security No. of Shares or Denomination  Method of Transfer 

                              Owner Last Name (20)             First Name (10)                       M.I. Suffix (3) Account Title (70) 

                           5  Owner Address 1 (30)                              Owner Address 2 (30)                                    Owner City (20)                 State (2)      Zip (9)          Country if Not USA 
         Lot No. 
                              Soc. Sec. No./Empl. ID No.   Property Type (2) Property ID Number (20)                 Date (MMDDYY)      Initial Amount Escheated Amount Removal Indicator (If Applicable, Enter “P” or “R”)   Multiple Owners 
                                                                                                                                                                                  P    Otherwise R                                        
         Reg.                                                                                                                      $                   $                Owner Claimed  Reduced to Zero                        Yes 
                              Description of Security (70)                                                                                               CUSIP Number of Security No. of Shares or Denomination  Method of Transfer