Oregon Administrative Rules
Chapter 170 - OREGON STATE TREASURY
Division 140 - UNCLAIMED PROPERTY CLAIMS
Section 170-140-0100 - Information Required on Property Claim Form

(1) To be complete, the Property Claim Form must include the Claimant's:

(2) If the Property is co-owned by another Person, the completed form may include the co-Owner's:

(3) An indemnity declaration immediately above the Claimant's signature and in prominent letters (e.g., bold type) that states, "I declare under penalty of perjury or mail fraud that to the best of my knowledge I am entitled to the assets of this Claim and agree to indemnify and hold the State Treasurer harmless for and from all claims, loss, costs, damages and expenses that State Treasurer may sustain by turning this asset over to me, or refusal to pay this asset or any part of it to any other person(s)."

(4) Claimant's signature. If the total value of the Property being claimed is more than $2,500.00, the Claimant's signature must be notarized.

(5) If the Claimant is not the original Owner, then the Claimant must provide a description of the relationship between the Claimant and the original Owner.

(6) If the Claimant is the heir or devisee of a deceased Owner, the Claimant must provide a description of the Claimant's relationship to the deceased Owner.

(7) To help expedite the Claim, the Claimant may voluntarily provide the Claimant's full or partial (i.e., last four digits) Social Security number to the Treasurer. The Treasurer will only: