City of Round Rock
Unclaimed Property
Individual Claim Form
The City of Round Rock holds property valued at $100 or less that is presumed abandoned or unclaimed subject to
Chapter 76 of the Texas Property Code. If you have unclaimed property, please submit this form and documentation
supporting your claim. All information will remain confidential.
Claimant Information (must be 18 years or older)
Claimant name:
First Middle
Last
Current Address:
Apt. #:
City: Zip:
Daytime phone number:
Social Security Number:
Driver’s License Number:
Previous address:
Amount Claimed:
Required Documentation
The following documents must be provided along with this claim form for the claim to be
processed.
A) Proof of Claimant’s Social Security Number
B) Copy of Claimant’s Driver’s License or any official form of identification
C) Proof of previous address (Copy of utility bill, canceled check, etc.)
Claimant Signature
The named Claimant hereby certifies that this claim for property presumed abandoned is valid and just, that all
statements herein are true and correct, and that upon payment of this claim said Claimant will indemnify and
hold harmless the City of Round Rock, and its officers and employees for any damages, claims or losses of any kind
resulting from the payment of the above described property to the Claimant.
Date: Claimant:
Co-Owner: Date:
Mail to:
City of Round Rock
Finance Department
Attn: Unclaimed Property
221 East Main Street
Round Rock, TX 78664
State:
Other phone:
