Fill - Free fillable Voluntary Disclosure Agreement (VDA) (Nevada State Treasurer) PDF form

STATE OF NEVADA

OFFICE OF THE STATE TREASURER

UNCLAIMED PROPERTY

Page 1 of 8

Rev. 11/2019

Voluntary Disclosure Agreement (VDA)

State of Nevada

Office of the State Treasurer

Unclaimed Property Division

555 E. Washington Ave. #5200

Las Vegas, NV 89101

www.nevadatreasurer.gov

Office: (702) 486-4140

Fax: (702) 486-4177

Section I – Holder Information

Name of Holder: _________________________________________________________

Address: ________________________________________________________________

City: _____________________________State:____________Zip:__________________

Contact Name: ________________________________Title:_______________________

Telephone: ____________________________Fax:______________________________

E-Mail:_________________________________________________________________

Company FEIN: __________________________________________________________

State of Incorporation: _____________________Date of Incorporation: ______________

Industry Type: ___________________________________________________________

If a 3

rd

party will be used in preparation of the report, please indicate the name of the firm

and provide contact information:

Name of Firm: ___________________________________________________________

Name of Contact: _________________________________________________________

Telephone: ________________________ Email: ________________________________

Section II – Holder Affiliate Information

List any affiliates or subsidiaries, along with the parent company, including their FEIN:

________________________________________________________________________

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NOTE: Each entity that has its own FEIN is required to file a separate VDA application

and file its own unclaimed property report.

Section III – Compliance Agreement

Upon signing this agreement, both the State of Nevada, Office of the State Treasurer,

Unclaimed Property Division, and the Holder certify that the following statements are

true and accurate:

1. The Holder is committed to becoming fully compliant with Nevada Revised

Statute (NRS) Chapter120A. The Holder will report and remit all unclaimed

property due by the agreed upon commitment date indicated on this form. The

Holder also is required to remain compliant for the next 3 reporting cycles or risk

being removed from the program and having the waived penalties and/or interest

reinstated and due immediately.

2. The Holder came forward voluntarily to enter into the Voluntary Disclosure

Agreement (VDA) and has had no prior contact by Unclaimed Property auditors

or other State of Nevada representatives to schedule or conduct an examination of

the books and records of the Holder.

3. The Holder has included with this VDA their Proposal of Reporting Method

Worksheet. This proposal, which the Unclaimed Property Division and the Holder

have mutually agreed upon, describes the Holder’s proposed method for

determining unclaimed property due or, if records are not available, describe the

technique for estimating their unclaimed property liability.

4. The Holder has included with this VDA a copy of their written policies and

procedures regarding unclaimed property to ensure compliance going forward.

5. Upon payment of the amount of unclaimed property and the submission of an

accurate report for the amounts determined to be due, the Holder is relieved of all

liability to the extent of the value of the property so paid to the Unclaimed

Property Division pursuant to NRS Chapter120A.

6. The Unclaimed Property Division may waive any penalty and/or interest

associated with the remittance of the property properly paid to the State of

Nevada pursuant to NRS120A.730. However, if the submission of the report and

payment is not received until after the agreed upon commitment date, penalties

and interest will be levied for the period from the commitment date to the date the

remittance is received.

7. The Holder will perform due diligence as directed in NRS 120A.560 (5) to

attempt to locate the rightful owner prior to turning the property over to the

Unclaimed Property Division.

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8. If upon receipt of the Holder’s report, it is determined that the Holder has not

acted in good faith or has materially failed to disclose the full amount of

abandoned or unclaimed property held by the Holder and payable to the State of

Nevada for the reporting years as disclosed in the Proposal of Reporting Method

Worksheet, then paragraph 6 of this agreement shall be null and void.

“Good Faith” requires that the Holder disclose to the Unclaimed Property

Division all determinations made in connection with this VDA, including all

items or types of property that the Holder has determined is not abandoned or

unclaimed property under the Nevada State Unclaimed Property Law, NRS

Chapter 120A.

Reliance on an independent third party to process the Holder’s books and records

and to determine the amount of abandoned or unclaimed property to be reported

and paid under this agreement does not in and of itself constitutes “good faith.”

9. The State of Nevada, Office of the State Treasurer, Unclaimed Property Division,

at its own discretion, retains the right to audit the Holder.

State of Nevada Treasurer’s Office Holder: ______________________

Name: Linda Tobin Name: _______________________

Signature: _______________________ Signature: _____________________

Title: Deputy Treasurer Title: _________________________

Date: ___________________________ Date: _________________________

Commitment Date: ______________

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Proposal of

Reporting Method Worksheet

(Use attachments if needed)

Have you ever filed an unclaimed property report with the State of Nevada?

_____No_____Yes If yes: Company Name Reported___________________________

Date of Filing___________Amount Reported_____________FEIN________________

Please answer each of the following questions for each property type (i.e.: payroll,

accounts payable, accounts receivable, securities, or other) listed.

If there is insufficient room to fully address the questions, please attach any further

explanation on a separate page. Please remember this is a one-time chance to clear

your books of all Unclaimed Property to be escheated to the State of Nevada, so

review all of your accounts before submitting.

Payroll

Are you including any payroll in your unclaimed property report? If not, please explain?

________________________________________________________________________

Your scope of review must at least cover the last seven reporting years. Please refer to

the Holder Reporting Manual for detail. Nevada currently has a dormancy period (the

period during which property remains unclaimed prior to being considered abandoned) of

one year for all payroll items, for a total of eight years. Please list the exact years for

which you will be reviewing your records.

________________________________________________________________________

Do you have the actual records for this property type for the full eight years? If not,

why?

________________________________________________________________________

If you do not have the records, how will you estimate the past due property? Please

describe in detail your proposed method or technique for estimating payroll.

________________________________________________________________________

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Accounts Payable

Are you including any accounts payable, such as vendor checks, in your report? If not,

please explain?

________________________________________________________________________

Your scope of review must at least cover the last seven reporting years. Nevada currently

has a dormancy period of three years for accounts payable checks for a total of ten years.

Please list the exact years for which you will be reviewing your records.

________________________________________________________________________

Do you have the actual records for this accounts payable for the full ten years? If not,

why?

________________________________________________________________________

If you do not have the records, how will you estimate the past accounts payable? Please

describe in detail your proposed method or technique for estimating accounts payable

property.

________________________________________________________________________

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Accounts Receivable Credit

Are you including any accounts receivable credits in your report? If not, please explain.

________________________________________________________________________

Your scope of review must at least cover the last seven reporting years. Nevada currently

has a dormancy period of three years for accounts receivable credits for a total of ten

years. Please list the exact years for which you will be reviewing your records.

________________________________________________________________________

Do you have the actual records for accounts receivable for the full ten years? If not,

why?

________________________________________________________________________

If you do not have the records, how will you estimate the past due property? Please

describe in detail your proposed method or technique for estimating accounts receivable

property.

________________________________________________________________________

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Securities (shares or dividends)

Are you including any securities? If not, please explain.

________________________________________________________________________

Your scope of review must at least cover the last seven reporting years. Nevada currently

has a dormancy period of three years for securities for a total of ten years. Please list the

exact years for which you will be reviewing your records.

________________________________________________________________________

Do you have the actual records for this property type for the full ten years? If not, why?

________________________________________________________________________

If you do not have the records, how will you estimate the past due property? Please

describe in detail your proposed method or technique for estimating any security items.

________________________________________________________________________

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Other Property (please describe in detail what kind)

Are you including any other property? If not, please explain. Examples would be gift

cards/certificates, utility deposits or money orders.

________________________________________________________________________

Your scope of review must at least cover the last seven reporting years. Please check

with the Unclaimed Property Division to determine the correct dormancy period for the

type of property you are listing. Please list the exact years for which you will be

reviewing your records.

________________________________________________________________________

Do you have the actual records for this property type for the required number of years? If

not, why?

________________________________________________________________________

If you do not have the records, how will you estimate the past due property? Please

describe in detail your proposed method or technique for estimating other types of

property.

________________________________________________________________________

______________________________________________________________________

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