CITY OF LOS ALTOS
UNCLAIMED PROPERTY-CLAIM FORM
Return completed form to:
City of Los Altos
Attn: Finance Department, AP
1 N San Antonio Road
Los Altos, CA 94022
Pursuant to California Government Code Section 50052, I wish to file a claim for a previously
unclaimed check in the amount of $_____________that was published in the Los Altos Town Crier
on _________. The grounds on which I file this claim are as follows:
__________________________ ___________________________________
Vendor or Individual Name (printed) Taxpayer I.D. or Social Security Number
_____________________________ ___________________________________
Vendor or Individual Name (signature) Telephone Number
______________________________________________________________________________
Address City/State/Zip Code
FOR FINANCE DEPARTMENT USE ONLY
Name of Payee: _________________ Original Check Amount: _______________
Original Check #:________________ Original Check Date: __________________
Replacement Check #:________________ Replacement Check Date: ______________
Replacement Check Amount: __________ Account Code: _______________________
Verified by: _________________________ Date: _______________________________
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