Required Owner Documentation for Claims

A claim for a check from the UPCF is initiated by the filing of a claim form, which must be completed with the following documentation. (1) If the owner is a person, the claimformmust include that individual’s notarized signature and his or her Social Security Number, and the owner must complete a W-9 form or an appropriate substitute (or a W-8 form for foreign owners). The claim form must be completed by the owner him/herself, or the conservator, and include a certification that the owner has not received a replacement check or otherwise been reimbursed. (2) If the owner is deceased and the claimis initiated on behalf of the decedent, the claim form must be signed by an individual entitled to act on behalf of the decedent and must include a stamped certificate of appointment as Executor/Executrixor Administrator/Administratrix, as wellas a copy of the decedent’s death certificate. For claims amounting to less than $700.00, however, the Deputy Treasurer may accept appropriate substitute documentation. (3) Ifthe claimis submitted on behalf of an active business, the individual signing the claim form must provide documentation verifying that he or she has the authority to submit the claim on behalf of the business, for example, an affidavit signed by an appropriate officer of the corporation stating that the individual signing the claim form has the authority to submit the claim on behalf of the corporation. (4) If the claim is submitted on behalf of a corporation whose dissolution has been completed, the individualsigningthe claim form must provide a copy of a Corporate RevivalCertificate issued bythe Secretary of State, as well as a copy of the articles of incorporation and mostrecentamendment, if any, resulting in a change of corporate officers, or, where appropriate, documentation certifying that the individual signing the claim form has been appointed as the receiver or the assignor for the benefit of creditors. (5) Ifthe claimis submitted on behalf of any other type of inactive business, the individual signing the claim form must provide verification that he or she is or was the principal owner of the business, or other documentation evidencing his or her right to take the property on behalf of the business, for example, a certified copy of a court order stating that the individual signing the claim form is the trustee of a dissolved or inactive business or documentation verifying the merger or acquisition of the business into or by another business, as well as the documentation required in 960 CMR 5.05(3). (6) If the claim form is signed by a trustee on behalf of a trust, a guardian, conservator, or other individual with legal authority to do so, he or she must submit the original document conferring legal authority to assert the claim, or a true attested/certified copy thereof.