-1-
Revised: 05/21/19
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Claim #:
AFFIDAVIT OF RELEASE BY CO-OWNER
STATE OF ______________________ )
COUNTY OF_____________________)
BEFORE ME, on this _____ day of ______
______, 20____, personally appeared,
______________________________, known to me to be a credible person and of lawful
(Name of Affiant)
age, who being by me first duly sworn on [ his or her] oath, depose and stated the following:
I am co-owner of the above referenced unclaimed property and release any and all ownership
interest in said.
property to _______________________, _________________, to claim on my behalf.
(Name of Recipient) (Relationship)
I declare under penalty of perjury under the law of the State of Nevada, that the foregoing is true and
correct.
IN WITNESS WHEREOF, I/We hereunto subscribe my name this _____ day of ____________,
20_______.
BY: ______________________
(Affiant)
Notary Signature: ______________________________
My Commission expires: ______________________________
ATTACH A COPY
OF A CURRENT GOVERNMENT-ISSUED PHOTO ID
MAIL COMPLETED FORM TO: NEVADA UNCLAIMED PROPERTY
555 E WASHINGTON AVE STE 4200
LAS VEGAS NV 89101-1070
To inquire about the amount you are
releas
ing, contact us at 702-486-4140 or
Unclaimedproperty@nevadatreasurer.gov
