Comptroller of Maryland 
                                                                                           Unclaimed Property Unit 
                                                                                           P.O. Box 17161 
                                                                                           Baltimore, Maryland 21297-1161 
                 Maryland Unclaimed Property Report                                        410-767-1700

Holder Name: ________________________________________________________     Holder Number: ______________________ 

For the year ended: __________________  Detail sheet number ______ of ______ 
• This form should accompany Form COD/CD 918. Do not list more than ten (10) owners using this form. 
• You may hand key this information electronically https://interactive.marylandtaxes.com/business/Compliance/UnclaimedPR/

Social Security/ OWNER            Account Number                             Property Type OFFICE USE ONLY Account Amount
FEIN Number      Name and Address                                                          Owner Number

COD/CD 919  06/16