New York ABP Code § 503

Report of abandoned property
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§ 503. Report of abandoned property. Each payment or delivery of\nabandoned property pursuant to section five hundred two shall be\naccompanied by a written report, affirmed as true and accurate under\npenalty of perjury, in such form as the state comptroller shall\nprescribe, setting forth:\n  (a) The name and last known address, if any, of the person appearing\nto be entitled to such abandoned property;\n  (b) A description of such abandoned property;\n  (c) The number of shares represented or the face amount of the\nsecurity;\n  (d) The amount of any principal, dividend, interest or other increment\ndue thereon;\n  (e) The date such amount was demandable or payable; and\n  (f) Such other identifying information as the state comptroller may\nrequire.\n

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