Confirm Agreement and eSignature

Step 4: Confirm and Sign
Congratulations! You are one step away from claiming your unclaimed properties!

To complete the claims process, confirm and agree to the information below by typing your name in the signature box and clicking the Agree button. By completing this step, your claim will be submitted to the Unclaimed Property Division.
BEING first duly sworn, the above claimant(s) deposes and represents as follows:
  • THAT I/we am/are submitting a claim for unclaimed property held by the Pennsylvania Treasury Department ("Treasury");
  • THAT I/we am/are entitled to the above unclaimed property, presently under the custodial control of Treasury. In consideration of receipt of the above-mentioned property ("property"), I/we agree to indemnify Treasury and hold Treasury and its employees and representatives harmless against any and all claims, costs, expenses (including reasonable attorney fees) or any other loss arising ut of the receipt, care and delivery of the property to me/us, or arising out of Treasury's refusal to deliver the property to any other persons or entities who may, in the future, be determined to be the rightful owner of the property.
  • THAT I/we agree that this Agreement shall be construed in accordance with laws of the Commonwealth of Pennsylvania; and
  • THAT I/we hereby acknowledge and understand that any false information and documentation supplied with the claim, which I/we do not believe to be true, will subject me/us to prosecution and penalties under 18 Pa C.S. §4904, (relating to unsworn falsification to authorities).


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