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Get 159 Form Report 2017-2024

REPORT CASH TOTAL NAME-PRINT INTEREST PENALTY TITLE TOTAL CASH REMITTANCE SIGNATURE TOTAL SHARES OF SECURITIES DATE FORM OF CASH REMITTANCE CHECK WIRE FOR OFFICE USE ONLY CD OR DISKETTE REPORT IMPORT LOADED KEYED BALANCED COMMITTED RECEIPT ID STOCK ID CUSIP SYMBOL CERTIFICATE DTC CUSTODIAN REV 10/2017 ASD-159. FORM ASD-159 Unclaimed Property Verification HOLDER NAME HOLDER ID IF KNOWN MAILING ADDRESS DATE OF INCORPORATION CITY STATE ZIP CODE CONTACT NAME CONTACT E-MAIL ADDRESS FEDERAL IDENTIFICATION NUMBER NUMBER OF EMPLOYEES CONTACT PHONE ----- Every person corporation or other business association banking or financial organization insurance company utility court or public authority etc. reporting unclaimed property must complete this form ASD-159. It is to be filed with the Annual Report Dormancy Period Chart for a listing of property types and associated dormancy periods covered by the North Carolina Escheat and Unclaimed Property Law North Carolina General Statute 116B. LATE FILING INTEREST PENALTY In addition to any other penalties any business government or organization holder filing after November 1 or life insurance holder filing after May 1 shall remit interest at the rate pursuant to North Carolina General Statute 116B77 currently 5. Interest penalty is computed as follows Total amount of property reportable X of days late/365 X 5 Interest Penalty. CERTIFICATION AND VERIFICATION As the person authorized to bind this holder I being duly sworn certify the attached report to be true and properly prepared and examined for correctness ensuring that all property eligible to be remitted is included in this return and the property reported has been held for the period required by North Carolina General Statute 116B-53. Further I certify and verify that notices pursuant to North Carolina General Statute 116B-59 were sent to the owners at their last known address. It is to be filed with the Annual Report Dormancy Period Chart for a listing of property types and associated dormancy periods covered by the North Carolina Escheat and Unclaimed Property Law North Carolina General Statute 116B. LATE FILING INTEREST PENALTY In addition to any other penalties any business government or organization holder filing after November 1 or life insurance holder filing after May 1 shall remit interest at the rate pursuant to North Carolina General Statute 116B77 currently 5. LATE FILING INTEREST PENALTY In addition to any other penalties any business government or organization holder filing after November 1 or life insurance holder filing after May 1 shall remit interest at the rate pursuant to North Carolina General Statute 116B77 currently 5. Interest penalty is computed as follows Total amount of property reportable X of days late/365 X 5 Interest Penalty. Interest penalty is computed as follows Total amount of property reportable X of days late/365 X 5 Interest Penalty. CERTIFICATION AND VERIFICATION As the person authorized to bind this holder I being duly sworn certify the attached report to be true and properly prepared and examined for correctness ensuring that all property eligible to be remitted is included in this return and the property reported has been held for the period required by North Carolina General Statute 116B-53. .

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