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                                   Unclaimed Property Claim Form & Checklist 
                                                         Comptroller of Maryland
                                                     Unclaimed Property Division
                                                     301 West Preston Street,Room 310
                                                     Baltimore, Maryland 21201-2385
                                                     410-767-1700, or 1-800-782-7383

See attachment for instructions
Please be sure to attach copies of all necessary documentation.
Part A - Claimant Information - Please print clearly

Name of Claimant(s)                                                         Social Security or FEIN Number Daytime telephone number

Address of Claimant(s)

City, state, zip code

Relationship to original owner                                                Email Address

Part B - Information on Property claimed - OFFICE USE ONLY

Original owner name                                                                                        Social Security or FEIN Number
Type of property                                              Holder name                                  Amount of Property

Part C - Provide the following documents

     Copy of your driver’s license or other ID (Required)
     Copy of Social Security Card or other documentation containing social security number (Required)
     Bank documents (e.g. passbook, bank statement, cancelled check) 
     Proof of affiliation with: 
     Letters of Administration                       Small Estate Papers          True Test Copy of Court Order 
     Copy of Death Certificate(s) for: 
     Other:

Part D – Affidavit
Under penalties of perjury, I (we) hereby certify that the foregoing information is true and correct. I (we) further certify that I (we) 
have not received any property claimed, are entitled to it and know of no other person who claims to be entitled to any portion. I 
(we) agree to indemnify the state of Maryland and its officers and employees for any loss of claim whatsoever resulting from the 
payment of this claim to me (us).

                               Signature of claimant                                       Signature of co-claimant
All services provided by the state Comptroller’s Office are free. Maryland law provides that you do not have to pay a fee to anyone 
for assisting you in recovering any property within 24 months of the date it was turned over to this office. Contracts which provide 
for a fee for such claims are unenforceable.

Part E - For office use only

Claim No.:  _______________________                  Control No.:  _____________________   Holder No.:  _____________________ 

Report Year:   _____________________                 Received:  _______________________    Total:       $ _____________________

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CLAIM YOUR PROPERTY

Submitting Claims for Individuals
1. Complete the information requested on the COT ST912 claim form.
2. Sign the form & attach the supporting documentation - see below.
3. Mail to the address located on the top of your claim form.

Submitting Claims for Businesses/Organizations
1. Complete the information requested on the COT ST912 claim form.
2. Updated W-9 (Required).
3. Provide information such as proof of address, ownership, or proof of authorization.
4. Provide additional information if it applies, such as proof of name change, affiliation, 
  merger, acquisition, proof of organization closed, dissolved, sold.
5. Have the form signed by two officers of the organization and provide copies of IDs.
6. For reporting organization error or reimbursement use COT/ST 917 claim form (used by 
  reporting organization requesting the return of funds from their own report).
7. Mail to the address located on the top of your claim form.
Submitting Claims for Deceased Owners and Estates
If there is a court-appointed estate representative, that person can submit a claim. If there is not a representative or 
the estate is closed, claims can be filed by:
• The surviving spouse, or
• Non-blood relative appointed by the court. (i.e. lawyer, banking institution etc.). In this case you will need to
  provide Letters of Administration or other letters of authority.
1. Complete the information in Part A of COT ST912 claim form and sign in Part D.
2. Attach a copy of the owner's death certificate and proof of address or ownership connecting the owner to the 
  address or funds.
3. Provide the following documents as they apply:
  o Letters of Administration from the Register of Wills.
  o Small Estate Papers.
  o Letters of Testamentary.
  o Copy of photo ID of person claiming the funds.
4. Mail to the address located on the top of the claim form.

Submitting Claims on Behalf of Another Person
1. You can submit claims as a parent, custodian, conservator, trustee, guardian, power of
   attorney, or legal representative on behalf of another person
2. Complete the information in Part A of COT ST912 claim form and sign in Part D.
3. Attach proof of address or ownership connecting the owner to the funds.
4. Provide the following documents as they apply:
  o Court documentation showing the authority to act on the original owner's behalf.
  o Power of Attorney documentation showing the original owner is living and you as designated Power of Attorney.
  o Copy of birth certificate of minor child.
  o Copy of your photo ID.
  o Copy of Social Security Card for minor & custodian.
5. Mail to the address located on the top of the claim form.

Submitting Claims for Joint Accounts or Multiple Owner Accounts
1. Complete the information in Part A of COT ST912 claim form and sign in Part D.
2. If it is a Joint Account, both owners must sign the claim form, as well as submit copies 
   of photo ID, proof of SSN and proof of ownership or address listed.
3. If one owner is deceased, or in the case of divorce or any other change associated with 
   the account, please submit supporting documentation
4. Mail to the address located on the top of the claim form

Supporting Documentation for Claims
o  All claimants must establish entitlement to the property sought.
o  Please follow the instructions on the claim form to determine what documentation must be provided.
o  If you still have questions, feel free to visit our FAQs.
o  You should receive your funds once your claim is approved, or our office will reach out if additional information is
   needed.
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