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2. Town of Castle Rock
   Unclaimed Property Claim Form - Payroll
4. Part A - Claimant Information
6. Relationship of the Claimant to the Owner*
   -- Select One --SelfSpouse HeirChild HeirPersonal Representative HeirAdministrator HeirOther HeirPower of AttorneyTrusteeParent/Legal GuardianParent of Minor or Incapacitate Person
7. Amount of Property Claimed*
9. First Name*
10. Last Name*
11. Middle Initial
13. Daytime Telephone Number*
14. E-mail Address*
16. Address*
18. City*
19. State*
20. Zip*
22. Previous Address or Special Notes
24. Original Owner Name*
26. Part B - Provide the Following Documents
28. Documentation Showing Proof of Address*
    i.e. Utility or insurance bill, NOT bank statement
30. Other
32. Part C - Affidavit
    Under penalties of perjury, I hereby certify that the foregoing information is true and correct. I further certify that I have not received any property claimed, are entitled to it and know of no other person who claims to be entitled to any portion. I agree to indemnify the Town of Castle Rock and its officers and employees for any loss of claim whatsoever resulting from the payment of this claim to me.
34. Signature of Claimant*
    Typed name serves as signature agreeing to above affidavit.
35. Current Date*
    Current Date
37. General Instructions
    If you are claiming property in the possession of the Town, you must complete and sign this claim form and forward it (either electronically or by mail), together with with the supporting documentation discussed below, to the Town of Castle Rock, Finance Department - Unclaimed Property, 100 North Wilcox Street, Castle Rock, CO 80104.
39. Supporting Documentation for Claims
    1 - You must submit two (2) forms of personal identification. If the claim is being filed by a party acting as a guardian, executor, administrator or in some other representative capacity, the appropriate documentation demonstrating entitlement to make the claim in that capacity must also be enclosed.
41. 2 - Documentation proving the reported property owner lived at the reported property address i.e. Utility bill, NOT bank statement
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field