Solano — Unclaimed Funds: Claim for Money Held

Source: https://solano.courts.ca.gov/system/files/claim-money-held-1.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SOLANO CLAIM FOR MONEY HELD

CLAIM FOR MONEY HELD

MAIL TO: Superior Court of California, County of Solano Attention: Fiscal Division (Escheatment) 600 Union Avenue Fairfield, CA 94533

DATE SUBMITTED: ______________________________________________

OWNER’S NAME: _____________________________________________

STREET ADDRESS: _____________________________________________

CITY, STATE, ZIP CODE: _____________________________________________

AMOUNT OF CLAIM: $____________________________________________

CLAIMANT’S NAME (Should match claim affirmation): _____________________________________________

RELATIONSHIP TO OWNER: ____________________________________________

REASON FOR CLAIM: _____________________________________________

A SEPARATE FORM IS REQUIRED FOR EACH ACCOUNT CLAIMED

AFFIRMATION AND SIGNATURE (by claimant)

I hereby affirm, under penalty of perjury, that I am duly authorized to make said claim upon the Superior Court of California, County of Solano. I hereby agree to indemnify and hold harmless the State, the Courts, its officer and employees from any loss, including attorney’s fees, incurred as a result of payment of the amount claimed.

Signature: ________________________________________ Date: ____________________

HOLDER’S USE ONLY (Court)

_____ Approved, Paid to Claimant Shown Above

_____ Denied, Not an Authorized Claim

By: ____________________________________ Date: ___________________

Hall of Justice Law and Justice Center Solano Justice Center 600 Union Avenue 530 Union Avenue 321 Tuolumne Street Fairfield, CA 94533 Fairfield, CA 94533 Vallejo, CA 94590