Interested Party Information

Name of the Estate(Required)

This information is provided in the correspondence that was mailed to you.

Name(Required)

Your legal name as it appears on your identification.

First Last

Address(Required)

Your current mailing address.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Social Security Number(Required)

Date of Birth(Required)

This information is needed before any distribution can be made to a beneficiary. If you do not provide the information any distribution you are entitled to will be paid to the County Treasurer. Please resubmit this form if any of your contact information changes.