Claimant Information
MARCELLE PRINCIVIL
2 GIFFORD PL 2 IRVINGTON
NJ 07111 US
*917-995-5813 METRO PCS
*STEPHANIEERNEST2@GMAIL.COM
11/16/1968 SELF UNKNOWN
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Owner Information
Owner Name PRINCIVIL MARCELLE Owner Address 2 GIFFORD PL APT 2 IRVINGTON NJ 07111
OUF Code 091526142 Reported By OFFICE OF THE STATE COMPTROLLER
Reported As PRINCIVIL MARCELLE
I am claiming the funds referenced above; held by the NYS Comptroller's Office of Unclaimed Funds. I am entitled to the funds and attest to the fact that these
funds have not been assigned or transferred to another party. I also attest to the fact that I used the address associated with the funds shown in the Owner Address.
In consideration of the payment of this claim, I will reimburse to the Office of the State Comptroller and the State of New York the amount due to any additional
persons who are entitled to these funds. Under penalty of perjury, I certify that the information I provided on this form is correct. This claim supersedes any and
all prior claims made by me or on my behalf.
- - Sworn to me this_____day of_____20___
___________________________________ ___________________________
Claimant's Signature Claimant's SSN/TIN
__________________________________________
___________________________________ Notary Public
Print Name
Required Documentation
• Sign the form and have your signature notarized by a licensed notary public.
• Attach proof of MARCELLE PRINCIVIL relationship to the address:2 GIFFORD PL APT 2 IRVINGTON NJ 07111
• Attach proof of MARCELLE PRINCIVIL relationship to the address:2 GIFFORD PL 2 IRVINGTON NJ, 07111 UNITED STATES
Return this form by mail: Contact us through the online contact form at https://www.osc.state.ny.us/unclaimed-
funds/claimants/contact-us#form
Office of Unclaimed Funds
110 State Street Visit our page at https://www.osc.state.ny.us/unclaimed-funds
Albany, NY 12236
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NYS Personal Privacy Protection Law Notification: The NYS Comptroller's Office of Unclaimed Funds (OUF) is requesting you to provide your Taxpayer
Identification Number and/or Date of Birth on this form in order to verify your identity and that you're entitled to claim the funds. OUF is authorized to collect
this information under Section 1406 of the NYS Abandoned Property Law. Disclosing this information is voluntary and we will process your claim without it.
However, in certain cases OUF is required to report the transaction to the Internal Revenue Service and/or other taxing authorities. If your claim is subject to such
a requirement, and you don't provide the requested information at this time, we'll require that you provide such information prior to payment. The information
provided will be maintained in the Unclaimed Funds Processing System under the direction of the Assistant Director of OUF, 110 State St. Albany, NY
12236.All claims are subject to audit. Any person knowingly submitting a fraudulent claim will be subject to legal penalties.
