The Delaware AP1 form is a report used to declare unclaimed or abandoned property in the state of Delaware. This form is essential for organizations such as banks and insurance companies to comply with state laws regarding unclaimed property. Proper completion and submission of the AP1 form help ensure that unclaimed assets are reported and handled correctly.
The Delaware AP1 form is a crucial document for organizations that manage unclaimed or abandoned property. This form serves as a report to the Delaware Division of Revenue, detailing the property that has been deemed unclaimed by its rightful owners. Organizations, such as banks and life insurance companies, must file this report within specific deadlines—by August 1st for banking entities and by May 1st for life insurance companies. The AP1 form requires detailed information about the reporting organization, including its federal employer identification number, name, and contact details. Additionally, it captures the type and value of unclaimed property, such as cash amounts, securities, and various accounts. Holders must also indicate whether they are submitting a final, supplemental, or preliminary report, ensuring that all relevant data is accurately presented. Verification of the report is essential, as it includes a sworn statement affirming the accuracy of the information provided. Proper completion of the AP1 form is vital for compliance with Delaware's unclaimed property laws, safeguarding both the interests of the reporting organizations and the rights of the property owners.
FORM AP1
STATE OF DELAWARE
Department of Finance
REPORT OF UNCLAIMED
Division of Revenue
OR ABANDONED PROPERTY
P O Box 8931
Wilmington DE 19899
Verification For Report Year 20_____
REPORT INFORMATION
Please Check One
[] Final Report - Date preliminary report filed ____________________
[] Supplemental report - Date previous report___________________
[] Preliminary Report
Media Submitted
[] Paper
[] Compact Disc
[] Diskette
Note: Preliminary reports are filed by Banking organizations, on or before August 1st, and by Life Insurance companies by or before May 1st only.
_______________________________________________________
HOLDER INFORMATION
Enter Your Federal E.I.#- 1 -______________________________
Company Name:________________________________________________________________________
Address:
___________________________________________________________________________
City,State, Zip
State of Incorporation: ___________________Date of Incorporation:__________________Primary SIC Code:___________________
Contact
Person:______________________________Email_________________________________Title:_____________________________
Telephone:________________________________FAX Number:__________________________________
1.Is the above a successor corporation Yes___No___? If you answered yes, please attach a listing of previous corporate names and date of acquisition.
2. Has the corporation changed names in the past year Yes___NO___? If yes please enter the following information:
Previous NameFederal E.I.#Date of Change
________________________________________________________
REPORT RECAPITULATION
OWNER & PROPERTY COUNT*
CASH AMOUNT
NUMBER OF SHARES
This report:
____________________
_____________________
For Banking organizations or Life Insurance companies, please complete the following calculation when
submitting a final or supplemental report:
Preliminary Report:
Additions:
Deletions:
Grand Total:
Advertising Expenses (Bank & Insurance Holders Only): ____________________
REMITTANCE AMOUNT & SHARES:
*Owner count is defined as the aggregate number of property owners; Property count is defined as the total number of individual property items being remitted. (Ex: Property owned jointly would have two owners, but count as only one piece of property)
HOLDER DELIVERY OF SECURITIES:
Holders delivering securities must provide account statements and documentation related to the State of Delaware Escheatment. Have securities been transferred to the State account: ______Yes ______ No
Are account statements and transfer documentation included with this report: ______Yes ______ No
_____________________________________________________________________________________
VERIFICATION
State of_________________________:
County of________________________: ss
I, ________________________________________ being first duly sworn, on oath depose and state that I have caused to be prepared and have
examined this report as to property presumed abandoned under the Delaware Unclaimed Property Law for the year ending as stated; that I am duly authorized by the holder to execute this report; and I believe that said report is true, correct and complete as of said date, excepting for such property as has ceased to be abandoned.
Signature__________________________________ Title________________________________________
Subscribed and sworn to before me this____________day of__________, 20_________.
DOCUMENT NO: 25-06/87/11/10
AP-1 CHECKLIST
# OWNERS / # PROP.
$ REPORTED
# SHARES
ACCOUNT BALANCES
AC01 Checking Accounts
AC02 Savings Accounts
AC03 Matured CD or Savings Certs.
AC04 Christmas Club Accounts
AC05 Money on Deposit to Secure Funds
AC06 Security Deposits
AC07 Unidentified Deposits
AC08 Suspense Accounts
AC99 Aggregate
TOTAL
UNCASHED CHECKS
CK01 Cashiers Checks
CK02 Certified Checks
CK03 Registered Checks
CK04 Treasurers Checks
CK05 Drafts
CK06 Warrants
CK07 Money Orders
CK08 Travelers Checks
CK09 Foreign Exchange Checks
CK10 Expense Checks
CK11 Pension Checks
CK12 Credit Checks or Memos
CK13 Vendor Checks
CK14 Checks Written off to Income
CK15 Other Official Checks
CK16 CD Interest Checks
CK99 Aggregate
COURT DEPOSITS
CT01 Escrow Funds
CT02 Condemnation Awards
CT03 Missing Heirs’ Fund
CT04 Suspense Accounts
CT05 Other Court Deposits
CT99 Aggregate
EDUCATIONAL SAVINGS ACCOUNTS
CS01 Cash
CS02 Mutual Funds
CS03 Securities
AP-1 CHECKLIST - CONTINUED
HEALTH SAVINGS PLAN
HS01 Health Savings Account
HS02 Health Savings Account
Investment
INSURANCE
IN01 Indiv. Policy Benefits or Claims
IN02 Group Policy Benefits or Claims
IN03 Proceeds Due Beneficiaries
IN04 Proceeds From Matured Policies,
Endowments or Annuities
IN05 Premium Refunds
IN06 Unidentified Remittances
IN07 Other Amounts Due Under Policy
IN08 Agent Credit Balances
IN99 Aggregate
IRA - TRADITIONAL, SEP, SARSEP, AND SIMPLE
IR01 Cash
IR02 Mutual Funds
IR03 Securities
IRA - ROTH
IR05 Cash
IR06 Mutual Funds
IR07 Securities
MINERAL PROCEEDS & INTERESTS
MI01 Net Revenue Interest
MI02 Royalties
MI03 Overriding Royalties
MI04 Production Payments
MI05 Working Interest
MI06 Bonuses
MI07 Delay Rentals
MI08 Shut-in Royalties
MI09 Minimum Royalties
MI99 Aggregate
AP-1 CHECKLIST - CONCLUDED
# OWNERS / #PROP.
MISC. CHECKS & INTANGIBLE PERSONAL PROPERTY
MS01 Wages, Payroll, Salary
MS02 Commissions
MS03 Workers Compensation Benefits
MS04 Payment for Goods & Services
MS05 Customer Overpayments
MS06 Unidentified Remittances
MS07 Unrefunded Overcharges
MS08 Accounts Payable
MS09 Credit Balances
MS10 Discounts Due
MS11 Refunds Due
MS12 Unredeemed Gift Certificates
MS13 Unclaimed Loan Collateral
MS14 Pension & Profit Sharing Plans
MS15 Dissolution or Liquidation
MS16 Misc Outstanding Checks
MS17 Misc Intangible Property
MS18 Suspense Liabilities
MS99 Aggregate
SAFE DEPOSIT BOX (SAFEKEEPING)
SD01 SD Box Net Proceeds
SD02 Other Safekeeping
SECURITIES
SC01 Dividends
SC02 Interest (Bond Coupons)
SC03 Principal Payments
SC04 Equity Payments
SC05 Profits
SC06 Funds to Purchase Shares
SC07 Funds for Stocks & Bonds
SC08 Shares of Stock (Returned by P.O.)
SC09 Cash For Fractional Shares
SC10 Unexchanged Shares of Successor Corp
SC11 Other Certs. of Ownership
SC12 Underlying Shares
SC13
of unsurrendered Stock or bonds
SC14 Debentures
SC15 US Government Securities
SC16 Mutual Fund Shares
SC17 Warrants (Rights)
SC18 Matured Bond Principal
SC19 Dividend Reinvestment Plans
SC20 Credit Balances
SC99 Aggregate
TRUST, INVESTMENT & ESCROW ACCOUNTS
TR01 Paying Agent Accounts
TR02 Undelivered or Uncashed Dividends
TR03 Funds Held In Fiduciary Capacity
TR04 Escrow Accounts
TR05 Trust Vouchers
UTILITIES
UT01 Utility Deposits
UT02 Membership Fees
UT03 Refunds or Rebates
UT04 Capital Credit Distributions
UT99 Aggregate
ALL OTHER PROPERTY NOT IDENTIFIED ABOVE
ZZZZ ALL OTHER PROPERTY
GRAND TOTAL *
* Please total all property categories and enter grand total on front of form AP-1 in the Report Recapitulation section.
(REVISED 02/ 17/ 11)
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