Michigan Department of Treasury                                                                              Reset Form
3433 (Rev. 12-18) 
Unclaimed Property Inquiry 
Issued under authority of Public Act 29 of 1995. 
Read the instructions on page 2 before completing this form. 
PART 1:  CLAIMANT/PROPERTY OWNER INFORMATION 
Property Owner’s Name (include current and all former names)          Property Owner’s Social Security or Federal Employer Identification Number 

Claimant Name                       Relationship to Property Owner    Claimant’s Social Security or Federal Employer Identification Number (if different) 

Current Address (Number and Street)                                                 Property Number(s) 

City, State, ZIP code                                                               Daytime Telephone Number 

E-mail Address 

PART 2:  FORMER ADDRESSES. List ALL former Michigan addresses used by the property owner. Attach a separate list, if necessary. 
                                Street Address                                      City, State, ZIP Code 

PART 3:  DECEASED PROPERTY OWNER. Refer to instructions for list of required documentation. 
1. Did the Decedent have a Will?                             Yes   No 
2. Did the Decedent have a Trust?                            Yes   No 2b. Is the Trust open?           Yes           No 
3. Did the Decedent have a Probated Estate?                  Yes   No 3b. Is Probated Estate open?     Yes           No 
PART 4:  CLAIMANT CERTIFICATION 
Under penalties of perjury, I certify that the information provided on this inquiry form is true to the best of my knowledge.  Upon payment 
of this claim, said claimant will indemnify and hold harmless the State of Michigan, officers and employees from any damages, claims 
or losses of any kind resulting in payment of the property being claimed. 
SUBSCRIBED AND SWORN TO BEFORE ME THIS                                           SIGNATURE(S) OF CLAIMANT(S) 

     DAY OF                                         , 20 

NOTARY PUBLIC                                    COUNTY, STATE 

MY COMMISSION EXPIRES 
Return completed form along with a copy of a picture identification, social security card, and required documentation (see page 2) to: 

Michigan Department of Treasury                                                     www.michigan.gov/unclaimedproperty 
Unclaimed Property 
P.O. Box 30756                                                                   Any additional properties that may belong to
Lansing, MI 48909                                                                   you will be added to your claim.
Allow 120 days for processing. 
                                                                 Office Use Only 
Approvals:            1.                         2.                3.            4.                5. 

3433, Page 2 
                                             Instructions for Form 3433, 
                                          Unclaimed Property Inquiry 

FORM INSTRUCTIONS                                                 Documentation required: 
                                                                  1. Did decedent have a Will?   
Part 1.  Complete applicable fields. 
                                                                         If yes, provide copy of Will. 
Part 2. List ALL former Michigan addresses used by the            2. Did decedent have a Trust?     
property owner, including P.O. Boxes.                                    If yes, provide a copy of the Trust. 
Part 3.  If property owner is deceased, answer all questions             Is the Trust open? 
and provide required documentation.                                      If yes, the Trustee is entitled to claim the property 
Part 4.  Sign in front of a Notary Public and have form                  on behalf of the Trust, the Trustee will need to  
notarized.                                                               complete this form. 
                                                                  3. If the decedent had a Probated Estate 
         REQUIRED DOCUMENTATION                                       Provide the following: 
                                                                         •   If open, send a current copy (dated within last 
                                                                         12 months) of your Letters of Authority issued by 
Individual Property Owner                                                the probate court certifying your appointment. 
                                                                         •   If closed, send a copy of the initial application/ 
Submit copies of the following documents (   originals will 
                                                                         opening petition for Probate and the Testimony to 
not be returned): 
                                                                         Identity Heirs. 
•  Picture ID (driver’s license or identification card) 
                                                                         •   A list of current addresses of all heirs. 
•  Social security card 
                                                                  Business Property Owner 
•  If your name differs from how it appears on the Unclaimed 
   Property Web site, submit legal documentation supporting                                                   
                                                                  Submit copies of the following documents:
   the name change (e.g. marriage certificate, adoption  
                                                                                   
   papers, divorce decree, etc.).                                 •  Business card
                                                                  •  Articles of Incorporation or DBA showing ownership 
Claimant Other Than Property Owner                                   of the business and name changes. 
                                                                  •  List of subsidiaries that entity can claim on behalf of. 
Submit copies of the following documents: 
                                                                  •  Documentation showing authorization for  you      to   act  
Parent on Behalf of a Minor                                          on behalf of the business entity shown as the original 
•  Parent’spicture   ID (driver’s license or identification card)    property owner. 
•  The minor child’s birth certificate and social security card. 
                                                                  Closed (But Not Sold) Entities 
                                                                                                                          
Guardian, Conservator, Trustee or Legal                           •  Final Federal tax return filed including Schedule K
Representative                                                    Sold Entities 
•  Claimant’s picture ID                                          •  Buy/sell agreement showing who owned the accounts 
•  Property owner’s picture ID and social security card              receivable at the close of sale. 
•  Court documents or other signed legal documents giving 
you authority to act on the property owner’s behalf.              Dissolved Entities 
                                                                  •  Dissolution papers and/or the automatic dissolution  
Deceased Property Owner                                              papers and a copy of the final corporate Federal tax  
                                                                     return, including Schedule K. 
All questions in Part 3 must be answered in order to process 
                                                                  •  List of current addresses of all shareholders. 
your inquiry.  All claims on behalf of deceased owners      must 
include the following documentation (originals  will not be  
                                                                  You may also be required to complete a formal   
returned): 
                                                                  claim form and provide additional documentation. 
•   Copy of Death Certificate 
                                                                  Allow 120 days for processing from the date form was 
•   Proof of your relationship to decedent (obituary, birth 
                                                                  mailed. 
   certificate, marriage license)