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 (By Power of Attorney) The Claim of Abandoned Property is made pursuant to Title 28, Chapter 29 Virgin Islands Code Owner’s Name: Name of Claimant By Power of Attorney: Social Security No./EIN (of Claimant by Power of Attorney) Mailing Address 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 Affidavit of Lost Instrument Certificate of Deposit Bank Certificate of Ownership Safe Deposit Receipt Copy of Power of Attorney Picture I.D. …
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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 (By Power of Attorney) The Claim of Abandoned Property is made pursuant to Title 28, Chapter 29 Virgin Islands Code Owner’s Name: Name of Claimant By Power of Attorney: Social Security No./EIN (of Claimant by Power of Attorney) Mailing Address 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 Affidavit of Lost Instrument Certificate of Deposit Bank Certificate of Ownership Safe Deposit Receipt Copy of Power of Attorney Picture I.D. Other DATE: CLAIMANT’S SIGNATURE: (Authorized by Power of Attorney) 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 Division of Banking, Insurance and Financial Regulation On behalf of the Abandoned Property Administrator ______________________________ Signature