CLAIM NUMBER : C010512722
DAVID SMITH If your address has changed, enter new address here :
PO BOX 184
_____________________________________________
EDDY, TX 76524
_____________________________________________
Claim for Unclaimed Property Pursuant to section 717.124, Florida Statutes
CLAIM FILED BY APPARENT OWNER
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NAME OF OWNER(S) CLAIMANT TYPE
SMITH, DAVID G PRIMARY
CLAIM AMOUNT : $8,564.50 CASH BALANCE : $8,564.50
ACCOUNT NUMBER : 139988248
COMPANY NAME : PHH MORTGAGE
TYPE OF PROPERTY : ESCROW FUNDS
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TO FILE YOUR CLAIM, FOLLOW STEPS 1-2-3-4. If filing on behalf of a business, also follow the instruction on the back of this form.
1. COMPLETE the following information:
Claimant's Social Security or FEID Number : _539-50-5435_____________ Date of Birth : ___07/01/2024__________
Home Phone : (________)________-______________ Office Phone : (________)________-______________
2. ATTACH the following as proof of ownership of the property :
Copy of Social Security Card, medicare card, W-2 Wage and Earnings statement, tax return or another official document that has name and
Social Security number. For business/corporation accounts, attach a copy of an official document that has name and Federal Employer
Identification number.
3. Each claimant shall provide the Department with a LEGIBLE COPY OF A VALID DRIVER'S LICENSE of the claimant at the time the
original claim form is filed. If the claimant has not been issued a valid driver's license at the time the original claim form is filed, the Department
shall be provided with a legible copy of a photographic identification of the claimant issued by the United States or a foreign nation, a state or
territory of the United States or foreign nation, or a political subdivision or agency thereof. In lieu of photographic identification, a Notarized
Sworn Statement by the Claimant, Form DFS-A4-2007, may be provided which affirms the claimant's identity and states the claimant's full name
and address.
4. SIGN AND DATE THE CLAIM FORM. NOTE: EACH CLAIMANT MUST SIGN THE CLAIM FORM. If one of the original owners is
deceased, please attach a certified copy of the death certificate for the deceased owner. This certificate will not be returned to you. By submitting
this claim, I acknowledge that the Department will use physical and electronic process to verify the information submitted.
CLAIMANT AFFIRMATION
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it are true; that all supporting
documentation is valid and unaltered; that the unclaimed property is due and owing to the claimant; and that I am authorized to file this claim. I
authorize the Division of Unclaimed Property to provide my name and address, as payee of the claimed property, to any claimant who may later
come forward with the substantiated proof to claim the property of this claim.
DAVID SMITH
____________________________________ _________________________________ 11/20/2024
______________
Claimant's Printed Name (Print Clearly) Claimant's Signature Date
____________________________________ _________________________________ ______________
Joint Claimant's Printed Name (Print Clearly) Joint Claimant's Signature Date
Once your fully-completed claim form is received with all the required documentation, it will be deemed complete. Please allow up to 90 days
from the date your claim is deemed complete for the Division of Unclaimed Property to make a decision on your claim.
Please return this completed claim form to :
Form DFS-UP-106
(Eff. 01/03/2005) Rule 69G-20.0021, F.A.C.
Department of Financial Services, Division of Unclaimed Property, P.O.Box 8599, Tallahassee, FL 32314-8599
Phone: 888-258-2253 (Inside Florida) (850)413-5555 (Outside Florida)
You can check the status of your claim online at www.fltreasurehunt.gov
FAILURE TO PROPERLY COMPLETE THIS CLAIM FORM AND TO INCLUDE REQUIRED DOCUMENTATION WILL RESULT IN
YOUR CLAIM BEING RETURNED TO YOU WITH INSTRUCTIONS TO PROVIDE ADDITIONAL INFORMATION.
Form DFS-UP-106
(Eff. 01/03/2005) Rule 69G-20.0021, F.A.C.
CLAIM NUMBER : C010512722
ADDITIONAL ACCOUNTS ARE LISTED BELOW. Please provide the requested documentation for each account.
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NAME OF OWNER(S) CLAIMANT TYPE
SMITH, DAVID PRIMARY
CLAIM AMOUNT : $108.66 CASH BALANCE : $108.66
ACCOUNT NUMBER : 138783583
COMPANY NAME : AT&T SERVICES INC
TYPE OF PROPERTY : REFUNDS
ATTACH the following as proof of ownership of the property:
Copy of a document that has name and the address that matches the address reported to this office for the owner (utility bill, bank statement, old
correspondence, deed). NOTE: Telephone and city directories ARE NOT acceptable as proof of address.
ADDRESS REPORTED: 970 BARCARMIL WAY NAPLES, FL 34110-0903
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NAME OF OWNER(S) CLAIMANT TYPE
SMITH, DAVID PRIMARY
CLAIM AMOUNT : $29.22 CASH BALANCE : $29.22
ACCOUNT NUMBER : 265484237
COMPANY NAME : COMENITY BANK
TYPE OF PROPERTY : MISCELLANEOUS CHECKS
ATTACH the following as proof of ownership of the property:
Copy of a document that has name and the address that matches the address reported to this office for the owner (utility bill, bank statement, old
correspondence, deed). NOTE: Telephone and city directories ARE NOT acceptable as proof of address.
ADDRESS REPORTED: 970 BARCARMIL WAY NAPLES, FL 34110-0903
The Department requests social security numbers in order to determine entitlement to unclaimed property pursuant to section 717.126, Florida
Statutes; to safeguard against fraudulent unclaimed property claims; and for the payment of claims. Social security numbers provided to the
Department in connection with claims are kept confidential and will not be released as public records.
Form DFS-UP-106
(Eff. 01/03/2005) Rule 69G-20.0021, F.A.C.
EQ Shareowner Services
PO Box 64945
St Paul MN 55164-0945
DAVID SMITH
PO BOX 184
EDDY, TX 76524
YEAR 2023 : DIVIDENDS AND DISTRIBUTIONS Confidential OMB No. 1545-0110 Form 1099-DIV
VENTAS, INC. PAYER’S name address PAYER’S TIN
COMMON STOCK VENTAS, INC. 61-1055020
EQUINITI TRUST COMPANY, LLC
View your tax documents, and more while signed into your account
1110 CENTRE POINTE CURVE- SUITE 101
at shareowneronline.com.
MENDOTA HEIGHTS MN 55120-4100
· New users can select Register then Register for Online
Access. Complete the form and select I don’t know for
Authentication type to have your Authentication ID sent to Account Number (see instruction) RECIPIENT’S TIN
you. VEN1 3400923624 539-50-5435
· Tax information is also available on our automated phone 1a. Total ordinary dividends 1b. Qualified dividends
system at 1-800-468-9716. $56.75 $1.65
· Investment Plan Participants: Total dividends reported may 2a. Total Capital gain distribution 2b. Unrecap. Sec. 1250 gain
include company paid brokerage commission and/or $3.37 $0.00
discounts on purchases. 2c. Section 1202 gain 2d. Collectible (28%) gain
Copy B For Recipient: This is important tax information and is $0.00 $0.00
being furnished to the Internal Revenue Service. If you are required 2e. Section 897 ordinary dividends 2f. Section 897 capital gain
to file a return, a negligence penalty or other sanction may be
imposed on you if this income is taxable and the IRS determines $0.00 $0.00
that it has not been reported. 3. Nondividend distribution 4. Federal income tax withheld
$6.24 $0.00
5. Section 199A dividends 6. Investments expenses
$55.10 $0.00
7. Foreign tax paid 8. Foreign country or U.S. possession
$0.00
9. Cash liquidation distributions 10. Noncash liquidation distributions
$0.00 $0.00
14. State and 15. State ID 16. State tax withheld
N/A $0.00
The Protecting Americans from Tax Hikes Act of 2015 (the “PATH Act”) provides that payers are no longer required to correct “de minimis” errors ($100 or less for a
previously reported income amount, or $25 or less for a previously reported withholding amount). To continue receiving corrected information tax returns for “de minimis”
errors, please send written notification with your name, address, taxpayer identification number (TIN), account number, and state you elect to receive “de minimis”
corrections.
Please submit request to Shareowner Services, P.O. Box 64860, Saint Paul, MN 55164-0860.
Tango1099 20241022
DAVID SMITH Page: 1 of 1
970 BARCARMIL WAY
Issue Date: Dec 15, 2020
NAPLES, FL 34110- 0903
Account Number: 298120339722
Please pay immediately to avoid interruption of service and additional fees. If service is
Total due
suspended due to non-payment then service is restored, a Restoral Fee of up to $35 will be
charged on your next bill.
Managing your AT&T bills, products, and services on the go? It's a snap with myAT&T. Go to
att.com/myatt to sign in or sign up.
$610.76
Due immediately: $343.44
Due Jan 04, 2021: $267.32
Account summary
Your last bill $458.14
Payments - Thank you! -$602.84
Adjustments $488.14
Past due - please pay immediately $343.44
Service summary
Account charges $7.00
Wireless $260.32
Total services $267.32
Total due $610.76
AutoPay is scheduled to charge your card on Jan 04, 2021
DAVID SMITH AutoPay of $610.76 is scheduled for
970 BARCARMIL WAY Jan 04, 2021
NAPLES, FL 34110- 0903
Account number: 298120339722
AT&T MOBILITY
PO Box 6416
Carol Stream, IL 60197-6416
979002981203397220000000002673200000061076002
