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Ouf C10CL01 30064162

Tamela Mitchell is required to submit specific documentation to claim unclaimed funds for the Estate of Barbara Jean Mitchell, including a Hold Harmless form and Letters of Voluntary Administration. The letter outlines the process for obtaining these documents and provides contact information for further assistance. The claim involves multiple accounts with a total amount of $1,801.12 from Jackson National Life Insurance Company.

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17 views3 pages

Ouf C10CL01 30064162

Tamela Mitchell is required to submit specific documentation to claim unclaimed funds for the Estate of Barbara Jean Mitchell, including a Hold Harmless form and Letters of Voluntary Administration. The letter outlines the process for obtaining these documents and provides contact information for further assistance. The claim involves multiple accounts with a total amount of $1,801.12 from Jackson National Life Insurance Company.

Uploaded by

tmvanilla
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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THOMAS P.

DiNAPOLI 110 STATE STREET


STATE COMPTROLLER ALBANY, NEW YORK, 12236

STATE OF NEW YORK


OFFICE OF THE STATE COMPTROLLER
OFFICE OF UNCLAIMED FUNDS
August 2, 2024
REFERENCE NUMBER: 16449563

TAMELA MITCHELL
380 MCLEAN AVE 1J
YONKERS NY 10705

Dear Tamela Mitchell,

Thank you for your inquiry regarding unclaimed funds held by this office.

We require the following documentation to process your claim:

• A completed Hold Harmless form with the notarized signature of the Estate Representative and the
Taxpayer Identification Number for the Estate of Barbara Jean Mitchell.

• Currently dated (within the last six months) Letters of Voluntary Administration for the Estate of Barbara
Jean Mitchell. To get the required Letters of Voluntary Administration, you must contact the Surrogates
Court in the county where the deceased last resided.

The court's seal or ink stamp must be easily identified.

Return requested documents, including your "Reference Number", by mail to the Office of Unclaimed Funds,
110 State St., Albany, NY 12236 or submit copies online at https://osc.ny.gov/ouf/cs.

You can check the status of your claim online and find additional information about unclaimed funds at
http://www.osc.ny.gov/ouf. Contact us at nysouf@osc.ny.gov or 1-800-221-9311 if your address changes or if
you need assistance.

Sincerely,

Julia A. Osborn
Assistant Director of Claimant Services
Office of Unclaimed Funds
THOMAS P. DiNAPOLI 110 STATE STREET
STATE COMPTROLLER ALBANY, NEW YORK, 12236

STATE OF NEW YORK


OFFICE OF THE STATE COMPTROLLER
OFFICE OF UNCLAIMED FUNDS
Estate Hold Harmless Form
August 2, 2024 REFERENCE NUMBER: 16449563

In consideration of the payment of this claim, the Estate will reimburse to the Office of the State Comptroller and the State
of New York the amount due to any additional persons who are entitled to these funds. Under penalty of perjury, I certify
that the information on this affidavit is true and correct and that the number shown on this affidavit is the correct Taxpayer
Identification Number.

______________________________________ ___________________________________
SIGNATURE OF ESTATE REPRESENTATIVE *ESTATE TAX IDENTIFICATION NUMBER

______________________________________ ___________________________________
CURRENT ADDRESS APT # DAYTIME TELEPHONE NUMBER

______________________________________ ___________________________________
CITY STATE ZIP EMAIL ADDRESS (if available)

ESTATE OF BARBARA JEAN MITCHELL

SWORN TO BEFORE ME THIS_____________

DAY OF_______________________, 20______

______________________________________
NOTARY PUBLIC

*An Estate Tax Identification Number (EIN) is only required when there is a court appointed estate representative.

Return this form by mail: Contact us: https://www.osc.state.ny.us/unclaimed-funds/claimants/contact-us


Office of Unclaimed Funds
110 State Street Visit our webpage at http://www.osc.state.ny.us/ouf/index.htm.
Albany, NY 12236
We invite you to like us on Facebook at facebook.com/nyscomptroller and
Submit online:
https://ouf.osc.state.ny.us/ouf/cs follow us on Twitter at @NYSComptroller
NYS Personal Privacy Protection Law Notification: The NYS Comptroller's Office of Unclaimed Funds (OUF) is requesting you to provide your Taxpayer Identification Number and/or
Date of Birth on this form in order to verify your identity and that you're entitled to claim the funds. OUF is authorized to collect this information under Section 1406 of the NYS
Abandoned Property Law. Disclosing this information is voluntary and we will process your claim without it. However, in certain cases OUF is required to report the transaction to the
Internal Revenue Service and/or other taxing authorities. If your claim is subject to such a requirement, and you don't provide the requested information at this time, we'll require that you
provide such information prior to payment. The information provided will be maintained in the Unclaimed Funds Processing System which is under the direction of the Assistant
Director of Services of OUF, 110 State Street, Albany, NY 12236
CLAIM PROPERTY LISTING REPORT
FOR INDIVIDUALS
New York State Office of Unclaimed Funds
August 2, 2024
REFERENCE NO. - 16449563

ACCOUNT TITLE: BARBARA JEAN MITCHELL ESTATE BENE BARBARA JEAN


MITCHELL INSURED
REPORTER NAME: JACKSON NATIONAL LIFE INSURANCE COMPANY
DORMANCY DATE: 2/9/2015
YEAR REPORTED: 2019
ACCOUNT NO.: 0507057315
OUF ACCOUNT NO.: 76322690
PROPERTY TYPE: DEATH CLAIMS
AMOUNT CLAIMED: $358.87

ACCOUNT TITLE: BARBARA JEAN MITCHELL ESTATE BENE BARBARA JEAN


MITCHELL INSURED
REPORTER NAME: JACKSON NATIONAL LIFE INSURANCE COMPANY
DORMANCY DATE: 2/9/2015
YEAR REPORTED: 2019
ACCOUNT NO.: 0541764029
OUF ACCOUNT NO.: 76322691
PROPERTY TYPE: DEATH CLAIMS
AMOUNT CLAIMED: $976.04

ACCOUNT TITLE: BARBARA JEAN MITCHELL ESTATE BENE BARBARA JEAN


MITCHELL INSURED
REPORTER NAME: JACKSON NATIONAL LIFE INSURANCE COMPANY
DORMANCY DATE: 2/9/2015
YEAR REPORTED: 2019
ACCOUNT NO.: 0543995600
OUF ACCOUNT NO.: 76322692
PROPERTY TYPE: DEATH CLAIMS
AMOUNT CLAIMED: $466.21

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