Form DFS-UP-155 "Safe Deposit Box Inventory Form of Property Presumed Unclaimed" - Florida

What Is Form DFS-UP-155?

This is a legal form that was released by the Florida Department of Financial Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 27, 2012;
  • The latest edition provided by the Florida Department of Financial Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DFS-UP-155 by clicking the link below or browse more documents and templates provided by the Florida Department of Financial Services.

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Download Form DFS-UP-155 "Safe Deposit Box Inventory Form of Property Presumed Unclaimed" - Florida

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DEPARTMENT OF FINANCIAL SERVICES
Division of Accounting and Auditing – Bureau of Unclaimed Property
SAFE DEPOSIT BOX INVENTORY FORM OF PROPERTY PRESUMED UNCLAIMED
IMPORTANT: MARK SHIPPING CARTON “DELIVER UNOPENED”
Mail Contents to:
State of Florida
Department of Financial Services
Bureau of Unclaimed Property
200 East Gaines Street
Tallahassee, FL 32399-0360
Unclaimed Property Identification Number (UPID) (From DFS-UP-111 Cover Sheet) __________________________________
Federal Tax Identification Number (FEID) _____________________________________ Branch #________________________
Branch Location/Address__________________________________________________________________________________
Owner’s Name____________________________________________________________________________________________
Owner’s Address_________________________________________________________________________________________
Safe Deposit Box #_________________________________ Date Drilled ________________ Rent Due $ _________________
Drilling Fee $______________ Prepared By ___________________________________ Date Prepared __________________
Operations Officer____________________________________________________ Date Prepared_______________________
Date Claimed By Owner______________________ Owner’s Signature_____________________________________________
Witnessed By_______________________________________________________ Date________________________________
Form DFS-UP-155, Revised 12/27/2012
DEPARTMENT OF FINANCIAL SERVICES
Division of Accounting and Auditing – Bureau of Unclaimed Property
SAFE DEPOSIT BOX INVENTORY FORM OF PROPERTY PRESUMED UNCLAIMED
IMPORTANT: MARK SHIPPING CARTON “DELIVER UNOPENED”
Mail Contents to:
State of Florida
Department of Financial Services
Bureau of Unclaimed Property
200 East Gaines Street
Tallahassee, FL 32399-0360
Unclaimed Property Identification Number (UPID) (From DFS-UP-111 Cover Sheet) __________________________________
Federal Tax Identification Number (FEID) _____________________________________ Branch #________________________
Branch Location/Address__________________________________________________________________________________
Owner’s Name____________________________________________________________________________________________
Owner’s Address_________________________________________________________________________________________
Safe Deposit Box #_________________________________ Date Drilled ________________ Rent Due $ _________________
Drilling Fee $______________ Prepared By ___________________________________ Date Prepared __________________
Operations Officer____________________________________________________ Date Prepared_______________________
Date Claimed By Owner______________________ Owner’s Signature_____________________________________________
Witnessed By_______________________________________________________ Date________________________________
Form DFS-UP-155, Revised 12/27/2012
OWNER’S NAME_____________________________________________________ SAFE DEPOSIT BOX # _______________________ PAGE________ OF________
Y/M = Yellow Metal
CONVERT ALL FACE VALUE MONIES TO CHECK PAYABLE TO:
W/M = White/Silver Colored Metal
DEPARTMENT OF FINANCIAL SERVICES
SB 08-NUMISMATIC
QTY
SBO1-JEWELRY
QTY
SB 13-US GOLD
QTY
US BILLS
Y/M NECKLACE(S)
U.S. PROOF / MINT SET (S)
U.S. $10,000.00 BILL(S)
Y/M NECKLACE W/PENDANT(S)
TOTAL OF COINS IN SETS
U.S. $1,000.00 BILL(S)
Y/M NECKLACE W/STONE(S)
U.S. $50.00 GOLD COIN (S)
U.S. $500.00 BILL(S)
NECKLACE W/PEARL-LIKE BEADS
U.S. $20.00 GOLD COIN (S)
U.S. $100.00 BILL(S)
Y/M RING(S)
U.S. $10.00 GOLD COIN (S)
U.S. $50.00 BILL(S)
Y/M RING W/STONE(S)
U.S. $5.00 GOLD COIN (S)
U.S. $20.00 BILL(S)
Y/M RING W/BEAD(S)
U.S. $2-1/2 GOLD COIN (S)
U.S. $10.00 BILL(S)
Y/M BRACELET(S)
U.S. $1.00 GOLD COIN (s)
U.S. $5.00 BILL(S)
Y/M BRACELET W/STONE(S)
U.S. GOLD PROOF/MINT SET (S)
U.S. $2.00 BILL(S)
Y/M BRACELET W/CHARM(S)
TOTAL # OF COINS (IN SET)
U.S. $1.00 BILL(S)
BRACELET W/PEARL-LIKE BEAD(S)
U.S. PLATINUM COIN (S)
SB 08-CONFEDERATE
QTY
Y/M PIN / BROOCH(S)
STATES PAPER MONEY
Y/M PIN / BROOCH W/STONE(S)
QTY
SB 03-NUMISMATIC COINS
CONFEDERATE $1000 BILL(S)
Y/M PIN / BROOCH W/BEAD(S)
U.S. COINS & COIN BOOKS
CONFEDERATE $500 BILL(S)
Y/M CHARM / PENDANT(S)
U.S. 1-DOLLAR COIN(S) LOOSE
CONFEDERATE $100 BILL(S)
Y/M PAIR OF CUFFLINKS
U.S. 1-DOLLAR ROLL(S)
CONFEDERATE $50.00 BILL(S)
Y/M SINGLE CUFFLINK(S)
U.S. 1-DOLLAR PARTIAL ROLL(S)
CONFEDERATE $20.00 BILL(S)
Y/M CAMEO STYLE PIN/PENDANT
U.S. 1-DOLLAR COIN BOOK(S)
CONFEDERATE $10.00 BILL(S)
W/M CAMEO STYLE PIN/PENDANT
TOTAL # OF COINS IN BOOKS
CONFEDERATE $5.00 BILL(S)
Y/M PAIR OF EARRINGS
CONFEDERATE $ 2.00 BILL(S)
Y/M PAIRS EARRINGS W/STONE(S)
U.S. 50-CENT COIN (S) LOOSE
CONFEDERATE $1.00 BILL(S)
Y/M SINGLE EARRING(S)
U.S. 50 CENT COIN ROLL (S)
Y/M SINGLE EARRING W/STONE(S)
U.S. 50 CENT PARTIAL ROLL (S)
GEM STONE(S)
U.S. 50-CENT COIN BOOK (S)
SB 09-FOREIGN PAPER
QTY
W/M NECKLACE(S)
TOTAL # OF COINS IN BOOKS
CURRENCY
W/M NECKLACE W/PENDANT(S)
W/M NECKLACE W/STONE(S)
U.S. 25-CENT COIN (S) LOOSE
QTY
SB 10-FOREIGN COIN(S)
W/M RING(S)
U.S. QUARTER ROLL (S)
W/M RING W/STONE(S)
U.S. QUARTER PARTIAL ROLL(S)
W/M BRACELET(S)
U.S. 25-CENT COIN BOOK (S)
SB 14-FOREIGN GOLD
QTY
W/M BRACELET W/STONE(S)
TOTAL # OF COINS IN BOOKS
COIN(S)
W/M BRACELET W/CHARM(S)
W/M PIN / BROOCH(S)
U.S. 10-CENT COIN (S) LOOSE
W/M PIN/BROOCH W/STONE(S)
U.S. 10-CENT COIN ROLL (S)
SB 15-FACE VALUE
QTY
W/M CHARM/PENDANT(S)
U.S. 10-CENT PARTIAL ROLL (S)
MONIES
W/M SINGLE CUFFLINK(S)
U.S. 10-CENT COIN BOOK (S)
$100.00 BILL(S) F/V
W/M PAIR OF CUFFLINK(S)
TOTAL # OF COINS IN BOOKS
$50.00 BILL(S) F/V
W/M PAIR OF EARRINGS
$20.00 BILL(S) F/V
W/M PAIR EARRINGS W/STONE(S)
U.S. 5-CENT COIN (S) LOOSE
$10.00 BILL(S) F/V
W/M SINGLE EARRING(S)
U.S. 5-CENT COIN ROLL (S)
$5.00 BILL(S) F/V
W/M SINGLE EARRING W/STONE(S)
U.S. 5-CENT PARTIAL ROLL (S)
$1.00 BILLS F/V (S)
MISC. JEWELRY PIECE(S)
U.S. 5-CENT COIN BOOK (S)
$0.50 CENT COIN(S) F/V
EARRING BACK(S), CLASP(S), ETC
TOTAL # OF COINS IN BOOKS
$0.25 CENT COIN(S) F/V
TIE TACK(S) & TIE CLIP(S)
$0.10 CENT COIN(S) F/V
TUXEDO BUTTON(S)/STUD(S)
U.S. 1-CENT(S) (PENNY)
$0.05 CENT COIN(S) F/V
MISC PIN(S)
U.S. 1-CENT PENNY ROLL(S)
$0.01 CENT COIN(S) F/V
MISC NECKLACE(S)
U.S. 1-CENT PARTIAL ROLL(S)
CONVERT TO CHECK
MISC BRACELET(S)
U.S. 1-CENT PENNY BOOK(S)
TOTAL # OF COINS IN BOOKS
OWNER’S NAME_____________________________________________________ SAFE DEPOSIT BOX # _______________________ PAGE________ OF________
SB 07-MISCELLANEOUS
QTY
SB 02-WATCHES
QTY
SB 07-MISCELLANEOUS VALUABLES
QTY
VALUABLES
Y/M WATCH W/BAND(S)
ARROW HEAD(S)
SILVER CANDLE HOLDER(S)
Y/M WATCH W/STONE(S)
BASEBALL(S)
SILVER FORK(S)
Y/M WATCH NO BAND(S)
BASEBALL CARD(S)
SILVER INGOT(S)
Y/M POCKET WATCH(S)
BELT BUCKLE(S)
SILVER KNIFE / KNIVES
Y/M POCKET WATCH W/CHAIN(S)
BEZEL(S) COIN, JEWELRY
SILVER MEDALLION(S)
BINOCULARS
SILVER SERVING PIECE(S)
Y/M POCKET WATCH W/CHAIN &
POCKET KNIFE
CALCULATOR(S)
SILVER SET(S) (# OF PIECES)
MISC. WATCH PARTS, BEZELS,
CAMERA(S)
# OF PIECES IN ALL SETS
BANDS. LINKS, ETC.
CARVED PIECES
SILVER SPOON(S)
WATCH CHAIN(S)
CHANGE PURSE OR PURSE
SILVER TRAY(S)
W/M WATCH W/BAND(S)
CLOCK(S)
SOUVENIR SPOON(S)
W/M WATCH W/STONE(S)
SPORTS MEMORABILIA
COMM. MEDALLION SET(S) &
W/M WATCH NO BAND(S)
TOTAL # OF MEDALLION(S)
SWEATER GUARD(S)
W/M POCKET WATCH(S)
COMMEMORATIVE MEDALLION
THIMBLE(S)
W/M POCKET WATCH W/CHAIN(S)
COMPACT(S)
U.S. STAMP(S)
EYE GLASSES
W/M POCKET WATCH W/CHAIN &
U.S. STAMP BOOK(S) &
POCKET KNIFE
FOREIGN STAMP(S)
# OF STAMPS IN BOOK(S)
FOREIGN STAMP BOOK(S) &
# OF STAMPS IN BOOK(S)
W/M KEY CHAIN(S)
GOLD BAR(S)
W/M LIGHTER(S)
QTY
SB 12-U.S. SAVINGS BONDS
GOLD CAPPED TOOTH / TEETH
W/M MONEY CLIP(S)
U.S. SAVINGS BOND(S) $10,000.00
HARMONICA(S)
WALLET(S)
U.S. SAVINGS BOND(S) $1,000.00
HISTORICAL DOCUMENT(S)
WAR MEDAL(S)
U.S. SAVINGS BOND(S) $500.00
KNIFE / KNIVES
WHISTLE(S)
U.S. SAVINGS BOND(S) $100.00
Y/M KEY CHAIN(S)
MANICURE SET(S) &
U.S. SAVINGS BOND(S) $75.00
TOTAL # OF PIECES IN SET(S)
Y/M LIGHTER(S)
U.S. SAVINGS BOND(S) $50.00
MILITARY PIN(S)
Y/M MONEY CLIP(S)
U.S. SAVINGS BOND(S) $25.00
MISC. BOOK(S) ALL KINDS
MISC. BOTTLES, PERFUME, PILL,
MISC. BUTTON(S)
MISC. DAMAGED COIN(S)
SB 05-BONDS
QTY
(NOT SAVINGS BONDS)
MISC. PIN(S)
OTHER BONDS (i.e State of Israel)
MISC. SHELL(S)
SB 06-PERSONAL
BEARER BONDS
MISC. TOKEN(S)
DOCUMENTS
MISCELLANEOUS BOXES (PILL,
WOOD, TIN, GLASS, JEWELRY)
MISC. ROCK (S)/STONE(S)
MISC. SILVER PIECE(S)
MUSIC BOX(S)
NAPKIN RING(S)
OLD MAGAZINE, COLLECTABLE
OLD NEWSPAPER, COLLECTABLE
QTY
SB 11-CHECKS
PEN/PENCIL(S)
CERTIFICATE(S) OF DEPOSIT
PEN-PENCIL SET / REFILLS &
TRAVELER’S CHECK(S)
NUMBER OF PIECES IN SET(S)
THIRD PARTY CHECK(S)
PICTURE(S), PAINTING(S)
OTHER CHECK(S)
POCKET KNIFE / KNIVES
PRAYER BEADS (ROSARY)
SILVER BOWL(S)
MISC. SOUVENIR’S
KEY(S)
LETTER OPENER(S)
OWNER’S NAME_____________________________________________________ SAFE DEPOSIT BOX # _______________________ PAGE________ OF________
SB 04-STOCK CERTIFICATES
QTY
COMPANY NAME
# SHRS
CERTIFICATE NUMBER
QTY
DESCRIPTIONS NOT LISTED ABOVE
TO LIST CONTENTS OF SAFE DEPOSIT BOXES CONTAINING SEVERAL ITEMS IN DIFFERENT CONTAINERS, I.E. JEWELRY ROLLS, BOXES, WRAPS, ETC.
LIST THE CONTAINER, QUANITY, AND THEN THE ITEMS IN THE CONTAINER.
QTY
QTY
QTY
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