HomeMy WebLinkAboutUnclaimed Monies Forms (1)CITY OF PALM DESERT
UNCLAIMED MONEY – CLAIM FORM
Return completed form to:
City of Palm Desert
Finance Department
73-510 Fred Waring Drive
Palm Desert, CA 92260
Pursuant to California Government Code Section 50052, I wish to file a claim for a previously unclaimed
check in the amount of $______________. I have attached a completed W-9 form and all documents
supporting my claim.
Vendor or Individual Name (Printed): _________________________________________
_______________________________ ________________________________
Vendor or Individual Name (Signature) Telephone Number
Address: ______________________________________________________________
______________________________________________________________________
City/State/Zip Code
For Finance Department Only
Proof of Identity Verified: ______ W-9 Form _____
Verified by: ____________________________Date: ____________________________
Claim Status: Approved ______ Rejected _____
Reason for rejection: _____________________________________________________
Reviewed by: ___________________________Date: ___________________________