Fillable SAFE DEPOSIT BOX DISPOSITION FORM You must use (State of Tennessee)

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SAFE DEPOSIT BOX DISPOSITION FORM You must use (State of Tennessee)

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Country of origin: US
File type: PDF

U.S.A. forms for State of Tennessee

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Reporting Help: UCP.holders@tn.gov
SAFE DEPOSIT BOX DISPOSITION FORM
You must use this form for your disposition report.
1. OWNER'S NAME AND ADDRESS / DATE OF LAST ACTIVITY: List the owner’s
complete name and last known address. Omit punctuation. Include the date of last
activity
.
2. RELATIONSHIP: If there are multiple owners, indicate the relationship between the
different owners (for example, JT TEN or Custodial).
3. SSN/FEIN: Indicate the owner’s tax ID number.
4. SAFE DEPOSIT BOX OR IDENTIFYING NUMBER: List the box number.
5. CONTENTS: This is your inventory of the box. Group items in categories (for
example, 5 - $50 EE bonds; 3 pieces jewelry, etc.)
6. AMOUNT DEPOSITED TO LESSEE’S ACCOUNT: If able to deposit any funds into
another account held by the lessee, list the amount.
7. CASH AMOUNT REMITTED: If cash amount is sent with the initial report, list the
amount. See T.C.A., Section 45-2-907 and Rule 1700-2-1-.37 for details when cash
may be remitted with the initial report.
8. IF SENT WITH REPORT: Check each item that you sent with your report.
9. RETURNED, SOLD OR DESTROYED: Indicate fi nal disposition of the property:
“Returned” if property was returned to the owner, “Sold” if property was sold in
accordance with T.C.A., Section 45-2-907 and Rule 1700-2-1-.37 and “Destroyed” if
property was destroyed in accordance with T.C.A., Section 45-2-907 and Rule
1700-2-1-.37.
10. NET PROCEEDS: Indicate the net amount due owner and sent with report after
disposition of safe deposit box contents. See T.C.A., Section 45-
2-907 and Rule 1700-2-1-.37 for applicable fees and charges you may deduct before
remitting.
11. TOTAL NET PROCEEDS: Enter the total amount sent with report.
PAGE NO. ______ OF______
PAGE TOTAL $___________
REPORT DATE _________________
FOR YEAR ENDED ______________
NAUPA CODE: SD01, SD02, SD03
STATE OF TENNESSEE
TREASURY DEPARTMENT
IV. REPORT OF UNCLAIMED
SAFE DEPOSIT PROPERTY
HOLDER NAME _____________________________
HOLDER NUMBER __________________________
HOLDER FEDERAL TAX ID NO. _________________
Please provide all data requested.
*If cash or securities, send to State of Tennessee.
Per rule 1701-2-1-.37, report contents of safe deposit box separate from other property types.
INSERT
DISPOSITION DATE
FOR (9) AND (10)
_________________
DATE
BOXES OPENED
AND INVENTORIED
_________________
TR-0392 (Rev. 10/05) RDA 1153
Owner's Name and Last
Known Address
(Alpha by Owner)
and Date of Last Activity
(1)
Relationship
Between
Owners
(If Applicable)
(2)
SSN/FEIN
(3)
Safe Deposit
Box or
Identifying
Number
(4)
Contents*
(5)
Net Amount
Deposited
to Lessee's
Account
(6)
Cash Amount
Remitted
With Intitial
Report
(7)
3 If
Sent
With
Report
(8)*
Returned,
Sold
or
Destroyed
(9)
Net Proceeds
Paid With
Disposition
Report
(10)
$$
Note: Remit by Check
(11) Remit Total
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SAFE DEPOSIT BOX DISPOSITION FORM You must use (State of Tennessee)

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Completed 20 July 2020

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