Fillable FORGED WARRANT(S) INVESTIGATION CLAIM FORM (Illinois State Treasurer's Office)

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FORGED WARRANT(S) INVESTIGATION CLAIM FORM (Illinois State Treasurer's Office)

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Illinois State Treasurer’s Office
Attn: Warrant Division/Forgery Section
400 West Monroe Street, Suite 401
Springfield, IL 62704
Phone: (217) 782-4117
Fax: (217) 558-4028
FORGED WARRANT(S) INVESTIGATION
CLAIM FORM
1. Claimant’s Name: __________________________________________________________
2. Claimant’s Address:__________________________________________________________
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3. Claimant’s Phone Numbers:(home)___________________ (work)______________________
4. State of Illinois Agency providing warrant(s):______________________________________
5. Do the funds from the warrant(s) rightfully belong to you: ________YES ________NO
6. Please provide detailed information explaining how you discovered that a forgery
has occurred in your name. (Print or type and use additional paper if needed).
01/11
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FORGED WARRANT(S) INVESTIGATION CLAIM FORM (Illinois State Treasurer's Office)

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Completed 20 July 2020

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