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2. UNCLAIMED PROPERTY – CLAIM FORM

   Pursuant to California Government Code Section 50052, I wish to file a claim for a previously unclaimed check published on City of Imperial Beach website.

4. Check #
6. Check Amount
8. The grounds on which I file this claim are:
10. First Name
11. Last Name
13. Taxpayer ID or Social Security #
15. Address
17. City
18. State
19. Zip Code
21. Phone Number
22. Fax Number
24. Email Address
26. Date
    Date
27. Signature
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28. Print Only

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