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           ,   20            ,   20  Country if Not USA    Country if Not USA   Country if Not USA    Country if Not USA    Country if Not USA   
Page _______ of _______ Page _______ of _______                                                       

  State (2)       Zip (9)    State (2)       Zip (9)    State (2)       Zip (9)       State (2)       Zip (9)       State (2)       Zip (9)  
      
                             P               Otherwise       R       Owner Claimed               Reduced to Zero                  Yes                              P               Otherwise       R       Owner Claimed               Reduced to Zero                   Yes                              P               Otherwise       R       Owner Claimed               Reduced to Zero                  Yes                              P               Otherwise       R       Owner Claimed               Reduced to Zero                  Yes                              P               Otherwise       R       Owner Claimed               Reduced to Zero                  Yes 
      
Escheated Amount       Removal Indicator (If Applicable, Enter “P” or “R”)       Multiple Owners    $            CUSIP Number of Security         No. of Shares or Denomination   Method of Transfer   Escheated Amount       Removal Indicator (If Applicable, Enter “P” or “R”)       Multiple Owners   $           CUSIP Number of Security         No. of Shares or Denomination   Method of Transfer   Escheated Amount       Removal Indicator (If Applicable, Enter “P” or “R” )      Multiple Owners   $           CUSIP Number of Security         No. of Shares or Denomination   Method of Transfer   Escheated Amount       Removal Indicator (If Applicable, Enter “P” or “R”)       Multiple Owners   $           CUSIP Number of Security         No. of Shares or Denomination   Method of Transfer   Escheated Amount       Removal Indicator (If Applicable, Enter “P” or “R”)       Multiple Owners   $           CUSIP Number of Security         No. of Shares or Denomination   Method of Transfer  
      
  Owner City (20)      Owner City (20)      Owner City (20)      Owner City (20)      Owner City (20)    
      
    $     $      $     $     $  
                                                     
   Date (MMDDYY)      Initial Amount           Date (MMDDYY)      Initial Amount       Date (MMDDYY)      Initial Amount       Date (MMDDYY)      Initial Amount    
   
                 Date (MMDDYY)          Initial Amount                
   
 M.I.          Suffix (3)      Account Title (70)      M.I.          Suffix (3)      Account Title (70)      M.I.         Suffix (3)      Account Title (70)     M.I.          Suffix (3)      Account Title (70)     M.I.          Suffix (3)      Account Title (70)    
   
 Owner Address 2 (30)     Owner Address 2 (30)     Owner Address 2 (30)      Owner Address 2 (30)      Owner Address 2 (30)    
   
REPORT OF ABANDONED PROPERTY                                              REPORT OF ABANDONED PROPERTY                                              
First Name (10)         First Name (10)      First Name (10)      First Name (10)     
   
                   First Name (10)                    
   
 Owner Address 1 (30)  Owner Address 1 (30)  Owner Address 1 (30)  Owner Address 1 (30)  Owner Address 1 (30) 
    
No.   No.                   Soc. Sec. No./Empl. ID No.     Property Type (2)     Property ID Number (20)          Description of Security (70)   2       Soc. Sec. No./Empl. ID No.     Property Type (2)     Property ID Number (20)          Description of Security (70)             Soc. Sec. No./Empl. ID No.     Property Type (2)     Property ID Number (20)          Description of Security (70)             Soc. Sec. No./Empl. ID No.     Property Type (2)     Property ID Number (20)          Description of Security (70)             Soc. Sec. No./Empl. ID No.     Property Type (2)     Property ID Number (20)          Description of Security (70)   
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No. No. No. No. No. 
 Reg.   Reg.   Reg.   Reg.   Reg.  
   
                                                      Owner Last Name (20)                                                     Lot                                                                                                      Owner Last Name (20)                                                     Lot                                                                                                      Owner Last Name (20)                                                     Lot                                                                                                      Owner Last Name (20)                                                     Lot                                                                                                      Owner Last Name (20)                                                     Lot                                                
AC 2686 (1/02)  STATE OF NEW YORK – OFFICE OF THE STATE COMPTROLLER – AC 2686 (1/02)  STATE OF NEW YORK – OFFICE OF THE STATE COMPTROLLER –  Do Not Write in This Area  Rec  Name of Reporting Organization                                                 Address of Reporting Organization                                                City                          State    Zip                                For The Period Ending  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 OUF USE ONLY                                                                                                                      






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