REPORT OF ABANDONED AND UNCLAIMED PROPERTY by StuartSpruce

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									  AP- 2   (1-09)          REPORT OF ABANDONED
                         AND UNCLAIMED PROPERTY
                              COMMONWEALTH OF PENNSYLVANIA
   FILE THIS COPY ON              TREASURY DEPARTMENT
  OR BEFORE APRIL 15th
                              BUREAU OF UNCLAIMED PROPERTY




HOLDER NAME

EIN #

REPORTING YEAR

PROPERTY DESCRIPTION



ACCOUNT NUMBER

OWNER EIN NUMBER
  OR
OWNER SOCIAL SECURITY NUMBER (Optional)

BUSINESS NAME/OWNER NAME
(FIRST NAME, MI, LAST NAME)

STREET ADDRESS

CITY                                STATE                    ZIP CODE

AMOUNT REPORTED AS DUE OWNER

NUMBER OF SHARES

ISSUE DATE

CHECK NUMBER

CERTIFICATE NUMBER

LAST ACTIVITY DATE

CUSIP NUMBER

ORIGINAL ISSUE NAME



                                                                        PAGE __________ OF __________
  AP- 2   (1-09)          REPORT OF ABANDONED
                         AND UNCLAIMED PROPERTY
                              COMMONWEALTH OF PENNSYLVANIA
   FILE THIS COPY ON              TREASURY DEPARTMENT
  OR BEFORE APRIL 15th
                              BUREAU OF UNCLAIMED PROPERTY




HOLDER NAME

EIN #

REPORTING YEAR

PROPERTY DESCRIPTION



ACCOUNT NUMBER

OWNER EIN NUMBER
  OR
OWNER SOCIAL SECURITY NUMBER (Optional)

BUSINESS NAME/OWNER NAME
(FIRST NAME, MI, LAST NAME)

STREET ADDRESS

CITY                                STATE                    ZIP CODE

AMOUNT REPORTED AS DUE OWNER

NUMBER OF SHARES

ISSUE DATE

CHECK NUMBER

CERTIFICATE NUMBER

LAST ACTIVITY DATE

CUSIP NUMBER

ORIGINAL ISSUE NAME



                                                                        PAGE __________ OF __________
  AP- 2   (1-09)          REPORT OF ABANDONED                                       NN
                                                                                         SYLVA
                                                                                                 N




                                                                               PE
                         AND UNCLAIMED PROPERTY




                                                                                                 IA
                              COMMONWEALTH OF PENNSYLVANIA




                                                                                                     T
                                                                              TRE




                                                                                                     EN
   FILE THIS COPY ON              TREASURY DEPARTMENT                            SU




                                                                                                 M
  OR BEFORE APRIL 15th




                                                                                A
                              BUREAU OF UNCLAIMED PROPERTY                            RY        RT
                                                                                         D E PA




HOLDER NAME

EIN #

REPORTING YEAR

PROPERTY DESCRIPTION



ACCOUNT NUMBER

OWNER EIN NUMBER
  OR
OWNER SOCIAL SECURITY NUMBER (Optional)

BUSINESS NAME/OWNER NAME
(FIRST NAME, MI, LAST NAME)

STREET ADDRESS

CITY                                STATE                    ZIP CODE

AMOUNT REPORTED AS DUE OWNER

NUMBER OF SHARES

ISSUE DATE

CHECK NUMBER

CERTIFICATE NUMBER

LAST ACTIVITY DATE

CUSIP NUMBER

ORIGINAL ISSUE NAME



                                                                        PAGE __________ OF __________
  AP- 2   (1-09)          REPORT OF ABANDONED                                       NN
                                                                                         SYLVA
                                                                                                 N




                                                                               PE
                         AND UNCLAIMED PROPERTY




                                                                                                 IA
                              COMMONWEALTH OF PENNSYLVANIA




                                                                                                     T
                                                                              TRE




                                                                                                     EN
   FILE THIS COPY ON              TREASURY DEPARTMENT                            SU




                                                                                                 M
  OR BEFORE APRIL 15th




                                                                                A
                              BUREAU OF UNCLAIMED PROPERTY                            RY        RT
                                                                                         D E PA




HOLDER NAME

EIN #

REPORTING YEAR

PROPERTY DESCRIPTION



ACCOUNT NUMBER

OWNER EIN NUMBER
  OR
OWNER SOCIAL SECURITY NUMBER (Optional)

BUSINESS NAME/OWNER NAME
(FIRST NAME, MI, LAST NAME)

STREET ADDRESS

CITY                                STATE                    ZIP CODE

AMOUNT REPORTED AS DUE OWNER

NUMBER OF SHARES

ISSUE DATE

CHECK NUMBER

CERTIFICATE NUMBER

LAST ACTIVITY DATE

CUSIP NUMBER

ORIGINAL ISSUE NAME



                                                                        PAGE __________ OF __________
  AP- 2   (1-09)          REPORT OF ABANDONED                                       NN
                                                                                         SYLVA
                                                                                                 N




                                                                               PE
                         AND UNCLAIMED PROPERTY




                                                                                                 IA
                              COMMONWEALTH OF PENNSYLVANIA




                                                                                                     T
                                                                              TRE




                                                                                                     EN
   FILE THIS COPY ON              TREASURY DEPARTMENT                            SU




                                                                                                 M
  OR BEFORE APRIL 15th




                                                                                A
                              BUREAU OF UNCLAIMED PROPERTY                            RY        RT
                                                                                         D E PA




HOLDER NAME

EIN #

REPORTING YEAR

PROPERTY DESCRIPTION



ACCOUNT NUMBER

OWNER EIN NUMBER
  OR
OWNER SOCIAL SECURITY NUMBER (Optional)

BUSINESS NAME/OWNER NAME
(FIRST NAME, MI, LAST NAME)

STREET ADDRESS

CITY                                STATE                    ZIP CODE

AMOUNT REPORTED AS DUE OWNER

NUMBER OF SHARES

ISSUE DATE

CHECK NUMBER

CERTIFICATE NUMBER

LAST ACTIVITY DATE

CUSIP NUMBER

ORIGINAL ISSUE NAME



                                                                        PAGE __________ OF __________
  AP- 2   (1-09)          REPORT OF ABANDONED                                       NN
                                                                                         SYLVA
                                                                                                 N




                                                                               PE
                         AND UNCLAIMED PROPERTY




                                                                                                 IA
                              COMMONWEALTH OF PENNSYLVANIA




                                                                                                     T
                                                                              TRE




                                                                                                     EN
   FILE THIS COPY ON              TREASURY DEPARTMENT                            SU




                                                                                                 M
  OR BEFORE APRIL 15th




                                                                                A
                              BUREAU OF UNCLAIMED PROPERTY                            RY        RT
                                                                                         D E PA




HOLDER NAME

EIN #

REPORTING YEAR

PROPERTY DESCRIPTION



ACCOUNT NUMBER

OWNER EIN NUMBER
  OR
OWNER SOCIAL SECURITY NUMBER (Optional)

BUSINESS NAME/OWNER NAME
(FIRST NAME, MI, LAST NAME)

STREET ADDRESS

CITY                                STATE                    ZIP CODE

AMOUNT REPORTED AS DUE OWNER

NUMBER OF SHARES

ISSUE DATE

CHECK NUMBER

CERTIFICATE NUMBER

LAST ACTIVITY DATE

CUSIP NUMBER

ORIGINAL ISSUE NAME



                                                                        PAGE __________ OF __________
  AP- 2   (1-09)          REPORT OF ABANDONED                                       NN
                                                                                         SYLVA
                                                                                                 N




                                                                               PE
                         AND UNCLAIMED PROPERTY




                                                                                                 IA
                              COMMONWEALTH OF PENNSYLVANIA




                                                                                                     T
                                                                              TRE




                                                                                                     EN
   FILE THIS COPY ON              TREASURY DEPARTMENT                            SU




                                                                                                 M
  OR BEFORE APRIL 15th




                                                                                A
                              BUREAU OF UNCLAIMED PROPERTY                            RY        RT
                                                                                         D E PA




HOLDER NAME

EIN #

REPORTING YEAR

PROPERTY DESCRIPTION



ACCOUNT NUMBER

OWNER EIN NUMBER
  OR
OWNER SOCIAL SECURITY NUMBER (Optional)

BUSINESS NAME/OWNER NAME
(FIRST NAME, MI, LAST NAME)

STREET ADDRESS

CITY                                STATE                    ZIP CODE

AMOUNT REPORTED AS DUE OWNER

NUMBER OF SHARES

ISSUE DATE

CHECK NUMBER

CERTIFICATE NUMBER

LAST ACTIVITY DATE

CUSIP NUMBER

ORIGINAL ISSUE NAME



                                                                        PAGE __________ OF __________
  AP- 2   (1-09)          REPORT OF ABANDONED                                       NN
                                                                                         SYLVA
                                                                                                 N




                                                                               PE
                         AND UNCLAIMED PROPERTY




                                                                                                 IA
                              COMMONWEALTH OF PENNSYLVANIA




                                                                                                     T
                                                                              TRE




                                                                                                     EN
   FILE THIS COPY ON              TREASURY DEPARTMENT                            SU




                                                                                                 M
  OR BEFORE APRIL 15th




                                                                                A
                              BUREAU OF UNCLAIMED PROPERTY                            RY        RT
                                                                                         D E PA




HOLDER NAME

EIN #

REPORTING YEAR

PROPERTY DESCRIPTION



ACCOUNT NUMBER

OWNER EIN NUMBER
  OR
OWNER SOCIAL SECURITY NUMBER (Optional)

BUSINESS NAME/OWNER NAME
(FIRST NAME, MI, LAST NAME)

STREET ADDRESS

CITY                                STATE                    ZIP CODE

AMOUNT REPORTED AS DUE OWNER

NUMBER OF SHARES

ISSUE DATE

CHECK NUMBER

CERTIFICATE NUMBER

LAST ACTIVITY DATE

CUSIP NUMBER

ORIGINAL ISSUE NAME



                                                                        PAGE __________ OF __________
  AP- 2   (1-09)          REPORT OF ABANDONED                                       NN
                                                                                         SYLVA
                                                                                                 N




                                                                               PE
                         AND UNCLAIMED PROPERTY




                                                                                                 IA
                              COMMONWEALTH OF PENNSYLVANIA




                                                                                                     T
                                                                              TRE




                                                                                                     EN
   FILE THIS COPY ON              TREASURY DEPARTMENT                            SU




                                                                                                 M
  OR BEFORE APRIL 15th




                                                                                A
                              BUREAU OF UNCLAIMED PROPERTY                            RY        RT
                                                                                         D E PA




HOLDER NAME

EIN #

REPORTING YEAR

PROPERTY DESCRIPTION



ACCOUNT NUMBER

OWNER EIN NUMBER
  OR
OWNER SOCIAL SECURITY NUMBER (Optional)

BUSINESS NAME/OWNER NAME
(FIRST NAME, MI, LAST NAME)

STREET ADDRESS

CITY                                STATE                    ZIP CODE

AMOUNT REPORTED AS DUE OWNER

NUMBER OF SHARES

ISSUE DATE

CHECK NUMBER

CERTIFICATE NUMBER

LAST ACTIVITY DATE

CUSIP NUMBER

ORIGINAL ISSUE NAME



                                                                        PAGE __________ OF __________
  AP- 2   (1-09)          REPORT OF ABANDONED                                       NN
                                                                                         SYLVA
                                                                                                 N




                                                                               PE
                         AND UNCLAIMED PROPERTY




                                                                                                 IA
                              COMMONWEALTH OF PENNSYLVANIA




                                                                                                     T
                                                                              TRE




                                                                                                     EN
   FILE THIS COPY ON              TREASURY DEPARTMENT                            SU




                                                                                                 M
  OR BEFORE APRIL 15th




                                                                                A
                              BUREAU OF UNCLAIMED PROPERTY                            RY        RT
                                                                                         D E PA




HOLDER NAME

EIN #

REPORTING YEAR

PROPERTY DESCRIPTION



ACCOUNT NUMBER

OWNER EIN NUMBER
  OR
OWNER SOCIAL SECURITY NUMBER (Optional)

BUSINESS NAME/OWNER NAME
(FIRST NAME, MI, LAST NAME)

STREET ADDRESS

CITY                                STATE                    ZIP CODE

AMOUNT REPORTED AS DUE OWNER

NUMBER OF SHARES

ISSUE DATE

CHECK NUMBER

CERTIFICATE NUMBER

LAST ACTIVITY DATE

CUSIP NUMBER

ORIGINAL ISSUE NAME



                                                                        PAGE __________ OF __________
          instructions for coMPLEtinG forM aP-2
       rEPort of aBanDonED anD uncLaiMED ProPErtY
                                      (All information must be typed)



    Holder Information:
     The name of the company filing the report.

    EIN Number:
     Company's Federal Employer Identification Number (Tax ID Number).

    Reporting Year(s):
     The year(s) for which this report is being filed.

     COLUMN ENTRIES
     Individual items of unclaimed property must be listed in groups according to the property
     type descriptions indicated on the checklist on the following page. Please use one page
     per property type description and list each item in either alphabetical order or numerical
     sequence by account number.

    Property Description:
     Description of property to be itemized on the AP-2 form. Please make copies of this page so that
     each page represents only one description of property.

    Property Identifier:
     The property number of each item in the appropriate column:
     (a) - account number
     (b) - check number
     (c) - certificate number

    EIN or Social Security Number:
     The company's Federal Employer Identification Number (Tax ID Number) if the owner is a business
     or Social Security number if the owner is an individual.

    Owner’s Information:
     The full name and last known address for each owner.

     • List full first name, middle initial, if available, and last name. List all information which would help
       with identification such as Jr., Sr.

     • Corporate titles should be entered exactly as adopted, except the word “the” should be deleted
       when it is the first word of the title.

     • List the complete address, including zip code. If the address is unknown, insert “address
       unknown” under the name.

     • If a single item has two or more owners, the names and addresses of both must be shown, along
       with the relationship (e.g. “Trustee”, “Or”, “And”, etc.). If the owners have the same address, the
       address may be entered once beneath the names.

“    Amount Reported As Due Owner:
     The amount due the owner.

    Number of Shares:
     The total number of shares due the owner prior to your liquidation of the shares.

    Issue Date / Last Activity Date:
     The issue date and/or last activity date. The issue date is the date a check or draft was issued, the
     date a gift certificate was purchased, etc. The last activity date is the date of the last deposit or with-
     drawal made by the owner.

     CUSIP Number:
11   The cusip of securities reported.

     Original Issue Name:
12   The original issue name of security, if known.

     Multiple Forms:
13   For multiple pages, list the page number in this space.

								
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