Stacy Garrity Bureau of Unclaimed Property

State Treasurer P.O.Box 1837

Harrisburg, PA 17105 - 1837
1(800)222-2046

You may be entitled to money from the Pennsylvania Treasury Department's Bureau of Unclaimed Property -- we want to help you claim
what's yours!

Unclaimed property includes things like abandoned bank accounts, forgotten stocks, uncashed checks, certificates of deposit, life insurance
policies, safe deposit box contents, and recovered stolen property.

It's easy for property to become unclaimed -- it happens all the time! Maybe you've moved, and your insurance company has been unable to
locate you. Or you forgot to cash an old rebate check. Whatever the case, your money belongs in your wallet!

Financial assets that have become dormant are considered to be unclaimed property. Dormancy in most cases is considered to be three years,
although there are some exceptions.

You have downloaded our claim form. It lists the property that may be yours. In order to claim that property, please follow the instructions
below carefully. Original documents will not be returned to you. To prevent unnecessary delays in processing your claim, please make sure
that any photocopies of documentation are readable, black and white copies on standard size, white paper. Because all of your
documentation is imaged upon receipt, it is advisable that you do not use a highlighter, staples or tape on any of the documents.

In order to claim the property, please complete the following steps:

If you are the property owner:

· Complete and sign the Claim Form.

· Each owner listed in Box A of the Property Description page must sign the enclosed forms. If an owner or beneficiary is
deceased, include a certified copy of the death certificate.

· If the name of the owner listed in Box A of the Property Description page has changed, provide documentation of the name
change. Examples of acceptable proof of name change include: marriage license, driver’s license, or official court document
confirming the name change. Copies are accepted.

· If you are in possession of the original property that is listed in Box F of the Property Description page, such as an uncashed
check or stock certificate, please return it along with your form(s).

· If you have a legal representative, such as an attorney, power of attorney, trustee or guardian, provide documentation authorizing
the representative to act on your behalf and to receive information regarding the claim.

· The custodian must complete and sign the enclosed form(s). If the custodian of the account is deceased, the parent or guardian of
the minor must determine who may claim the property. A certified copy of the death certificate for the custodian must be
provided.

· If an address is listed in Box B of the Property Description section, provide proof of residing at that reported address. Examples
of acceptable proof of the reported address include: utility bill, pay stub, bank statement, or any other document confirming the
reported address. Copies are accepted.

5/19/2022 Claim ID : 21272929

Additional documentation may be requested to prove you are the rightful owner.

Pennsylvania law requires the State Treasurer to sell all stocks, bonds, and other negotiable financial instruments upon receipt of such items.
Therefore, in such cases, you will not receive the actual physical certificate but will instead receive a check representing the net value of the
shares as of the date of liquidation.

If you received a PDF claim form, complete the form electronically, save the form, and upload your completed claim form at
https://unclaimedproperty.patreasury.gov/en/Claim/ClaimStatus?source=ClaimStatus.

You will be required to enter your zip code and claim number OR if you created a Log In, you may log in to access the link to upload
documents.

Print and mail your completed documents to: Pennsylvania Treasury Department, Bureau of Unclaimed Property, P.O. Box 1837,
Harrisburg, PA 17105-1837. Our Return Team stands ready to assist you at 1-800-222-2046.

However, the original document(s) must be provided for the following:

· Bearer bonds

· Interest coupons or bearer bonds

· Cashier checks

· Money order

The original document is required in order to process your claim for the types of documents listed above. Mail the original document(s) with
your claim number by regular US Postal or priority mail to: Pennsylvania Treasury Department, Bureau of Unclaimed Property, P.O. Box
1837, Harrisburg, PA 17105-1837. Failure to mail us the original document(s) may result in delayed processing of your claim.

5/19/2022 Claim ID : 21272929

 Claim ID: 21272929

Stacy Garrity, State Treasurer

Property ID's: 24473240
PROPERTY DESCRIPTION
Property / Holder Information(s) Property ID :24473240
(A) Original Owner's Name (B) Original Owner's Address as Reported
NGUYEN PHUONGHUYNH 5453 YOUNGRIDGE DR APT 21, PITTSBURGH, PA 15236
(C) Holder Reporting Funds (D) Last Transaction Date
CITIZENS BANK OF PENNSYLVANIA (060) 2/13/2014
525 WILLIAM PENN PLACE, PW2140, PITTSBURGH, PA 15219
(F) Type of Funds Reported (G) Certificate, Policy or Check Number
OTEX - UNCLAIMED CHECK / OFFICIAL CHK Reference:
Cusip:

5/19/2022 Claim ID : 21272929

Stacy Garrity
State Treasurer

Claim ID: 21272929

OWNER CLAIM FORM

CLAIMANT INFORMATION

PLEASE COMPLETE ALL INFORMATION BELOW:

YOUR NAME(S): PHUONG HUYNH NGUYEN DATE OF BIRTH: 2/12/1989

CURRENT MAILING ADDRESS: 13611 Flying Squirrel Drive

CITY/STATE/ZIP: Herndon, VA 20171

DAYTIME PHONE NUMBER: (814) 442-3106 CELL PHONE NUMBER:

EMAIL ADDRESS: liyah.nguyen@icloud.com SOCIAL SECURITY NUMBER:

I AUTHORIZE THE MAILING OF MY PAYMENT TO THE ADDRESS OF THE LAW OFFICE PROVIDED HERE.

PROPERTY / HOLDER INFORMATION

Property ID Property Description Holder

24473240 UNCLAIMED CHECK / OFFICIAL CHK CITIZENS BANK OF PENNSYLVANIA (060)

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 claimed property, presently under the custodial control of Treasury.

In consideration of the 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 out 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 the laws of the Commonwealth of Pennsylvania; and

THAT I/we hereby acknowledge and understand that any false information and/or 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).

X ________________________________ X ________________________________
Signature of Claimant Signature of Additional Claimant(s)

IMPORTANT INFORMATION REGARDING YOUR PAYMENT.

The Pennsylvania Treasury Department is responsible for custodial care of unclaimed property. It is proactive of Treasury not to allow the
forwarding of checks through the United States Postal Service, even if you have a mail forward notice filed with the Post Office. If you have
moved since initially filing your claim (in other words, if your mailing address is different from the address you provided at the time of filing
your claim), please contact us at 1-800-222-2046 to provide your updated mailing address directly.

Failure to contact Treasury with your current address may result in delays in receiving your unclaimed property.

5/19/2022 Claim ID : 21272929

THIRD PARTY INFORMATION
State law limits the fee a third party can charge an owner for the recovery of unclaimed property to 15 percent of the property
value. Please contact the Bureau of Unclaimed Property at 1-800-222-2046 with any additional questions.

** If You Paid A Fee To Claim Your Property, Please Complete The Following**

The Pennsylvania Treasury Department does not charge a fee to claim or recover unclaimed property. Third parties who assist with the
recovery of unclaimed property are subject to requirements set forth under section 1301.11 of Pennsylvania's Unclaimed Property Act. They
must disclose the nature and value of the property as well as where it is being held. (Pennsylvania Treasury Department).The fee a third
party can charge to assist with the recovery of property cannot exceed 15 % of the total value of the property.

Was/Is a third party involved in providing this claim form to you/the claimant or assisting with the claim in any way? If so, please state the
amount of such fee or payment.

_______Yes _______No $___________Please specify amount of fee / payment.

Third Party Information:

Name:

Address:

Phone Number:

Registration Number:

Email Address:

Please be advised that, effective January 12, 2015, a person may not engage in and receive compensation for any activity for the
purpose of locating or assisting in the recovery of unclaimed property on behalf of another, without first obtaining a Certificate of
Registration from the State Treasurer, which includes a registration number. For more information, visit www.patreasury.gov.

5/19/2022 Claim ID : 21272929