Property ID: Owner: Holder Name: Report Received Date: Property Description: Security Information: Value
Claimant Information
Name(s) if different than above: Daytime Phone: (775) 233-7593
Mailing Address: SSN or FEIN:
City, State, Zip: Email: burtontyvail38@gmail.com
Change of Address: If your mailing address changes after you upload or mail this form, please contact our office immediately; otherwise, your check will be mailed to the address listed above in Claimant information. In order to change the address, we will also require proof to be uploaded to the claim.
Affidavit
Under penalties of perjury, I certify that the information provided for this claim is true, and all supporting documentation presented is either original or true unaltered copies of the originals. Upon payment of this claim, said claimant will indemnify and hold harmless the State of Nevada, Officers and Employees from any damages, claims or losses of any kind resulting in payment of the above described property to the claimant under the provisions of Nevada Revised Statutes (NRS) Chapter 120A.
Signature of Claimant: Date:
Signature of Co-Claimant: Date:
Optional Voluntary Donation Election
Teachers' School Supplies Reimbursement Account Donation
DONATE DO NOT DONATE
By circling DONATE you are authorizing the State of Nevada to donate your Unclaimed Property identified in the claim above, to the Teachers' School Supplies Reimbursement Account per NRS 120A.645. Once your claim has been approved, the funds will be transferred. Note that donations will only be completed on claims where the claimant indicated an interest to donate the claim funds and the final claim value is less than $500.00.
Final Instructions
Please return the signed (and notarized, if required) claim form along with ALL the documentation listed in the Documentation Required section to our office. Please note that your payment will be limited to the amount we can verify belongs to you and may not match what is currently showing on your claim form. In addition, more information may be requested after initial review.
For fastest processing, upload the claim form and documentation via our website at https://www.NVUP.gov/app/claim-doc-upload.
You may also mail the documents to our office at the address listed below:
Nevada Unclaimed Property 1 State of Nevada Way, Suite #410 Las Vegas, NV 89119
Emailed and Faxed documents may not be accepted or processed.
If you have questions, please call (702) 486-4140 or email unclaimedproperty@nevadatreasurer.gov
Check the status of your claim on our website at: https://www.nvup.gov/app/claim-status-search