CLAIM OF ABANDONED PROPERTY by Power of Attorney
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 Banking and Insurance On behalf of the Abandoned Property Administrator ______________________________ Signature