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Vermont State Treasurer’s Office -- Unclaimed Property Division

109 State Street, Montpelier, Vermont 05609-6200


UNCLAIMED PROPERTY REPORT - SCHEDULE B (Securities)

Holder Name ___________________________________ Holder FEIN ___________________ Report Date ________________

Holder ID ______________________________________ For Year Ended _____________

Relationship Code

Code NAUPA
Last Transaction or
Owner’s Last Name, First Name, Middle Date Property
Name; SSN/FEIN Became Payable or SECURITY NAME CUSIP NUMBER OF SHARES
Owner’s Last Known Street Address Distributable to the
City, State, Zip Owner

1 2 3 4 5 6 7 8

Number of Properties ________________

Page Total # of Shares__________________