CLAIM OF ABANDONED PROPERTY
GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF BANKING, INSURANCE AND FINANCIAL REGULATION 5049 Kongens Gade, St. Thomas, VI 00802-6487 • Tel: 340-774-7166 • Fax: 340-774-9458 1131 King Street, Suite 101, Christiansted, VI 00820 • Tel: 340-773-6459 • Fax: 340-719-3801 CLAIM OF ABANDONED PROPERTY (Deceased) The Claim of Abandoned Property is made pursuant to Title 28, Chapter 29 Virgin Islands Code Name of Deceased: Last Address of Deceased: Claimant’s Names: Mailing Address of Claimant: Telephone Number: Home: Work: Other: Name of Institution Account No.: Safe Deposit Box No.: Policy No.: Certificate No.: _________________________ Amount: Description of Contents: The following documents are attached in support of this claim: Passbook Bank Certificate of Ownership Certificate of Deposit Death Certificate Safe Deposit Receipt Marriage Certificate Picture I.D. Birth Certificate Affidavit of Lost Instrument Copy of Judicial determination, i.e., Probate Will, Order, Decree. …
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GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF BANKING, INSURANCE AND FINANCIAL REGULATION 5049 Kongens Gade, St. Thomas, VI 00802-6487 • Tel: 340-774-7166 • Fax: 340-774-9458 1131 King Street, Suite 101, Christiansted, VI 00820 • Tel: 340-773-6459 • Fax: 340-719-3801 CLAIM OF ABANDONED PROPERTY (Deceased) The Claim of Abandoned Property is made pursuant to Title 28, Chapter 29 Virgin Islands Code Name of Deceased: Last Address of Deceased: Claimant’s Names: Mailing Address of Claimant: Telephone Number: Home: Work: Other: Name of Institution Account No.: Safe Deposit Box No.: Policy No.: Certificate No.: _________________________ Amount: Description of Contents: The following documents are attached in support of this claim: Passbook Bank Certificate of Ownership Certificate of Deposit Death Certificate Safe Deposit Receipt Marriage Certificate Picture I.D. Birth Certificate Affidavit of Lost Instrument Copy of Judicial determination, i.e., Probate Will, Order, Decree. DATE: CLAIMANT’S SIGNATURE: Relationship to Deceased: For Office Use Only Listing No: Year: Page No.: The claim has been allowed The claim has been denied: In Whole/In Part Director of Banking and Insurance On behalf of the Abandoned Property Administrator ______________________________ Signature