Initiated Date: 4/23/2023 OFFICIAL USE ONLY
Source: MVF WEB
Relationship: Owner
Printed Date: 4/23/2023
Claim ID: 20939307
MALIA M. COHEN
California State Controller
UNCLAIMED PROPERTY DIVISION
Unclaimed Property Claim Affirmation Form
SHAUN SOTO
3461 MINES RD
Livermore, CA 94550
This is to inform you that the property listed below may belong to you.
This property was turned over to the State Controller’s Unclaimed Property Division, as required by law, for
safekeeping until it can be claimed by the rightful owner or their heirs. California’s unclaimed property law
requires businesses to submit property, such as bank accounts, stocks, bonds, and the contents of safe deposit
boxes, to the state if there has been no activity on the account, or the business has had no contact with the
owner, generally for three years.
To claim this property, or the net proceeds of any sale of property as required by law, please complete Sections
C and D of this form and return it with the required documentation to the address below. If you do not have all
of the items required, please send as much information as possible to prove you are the owner of the property.
Once your signed Claim Affirmation Form and required documentation have been received, please allow up to
180 days for processing. For more information about this program including filing instructions, forms, or to
inquire about your claim status, please visit the State Controller’s website at www.claimit.ca.gov. Claimants
may also contact the Unclaimed Property Division by phone at (800) 992-4647. International callers should call
(916) 323-2827 for inquiries.
PLEASE NOTE: Properties recently transferred to the State Controller’s Office may not appear on our
website. If you have an outstanding debt with a California state agency, city or county, your unclaimed property
payment may be intercepted to pay the debt.
Section A - Property Owner Information
Owner(s) Name Reported Owner Address
CASINOS VIRGINIA 1158 SUNNYVALE SARATOGA RD, APT 43, SUNNYVALE, CA 94087
Type of Property Reported By Property ID Number
Refunds or Rebates MANAGED RISK MEDICAL INSURANCE 976919384
BOARD
Cash Reported Shares Reported Name of Security Reported
$12.00
Owner(s) Name Reported Owner Address
GOLDEN WEST CASINO UNION AVE, BAKERSFIELD, CA 93304
Type of Property Reported By Property ID Number
Misc Outstanding Checks COSTCO WHOLESALE CORPORATION 977082678
Cash Reported Shares Reported Name of Security Reported
$65.00
Unclaimed Property Division
MAILING ADDRESS P.O. Box 942850, Sacramento, CA 94250-5873
10600 White Rock Road, Rancho Cordova, CA 95670
(800) 992-4647 (Nationwide) or (916) 323-2827 (Outside of US) Page 1 of 8
Initiated Date: 4/23/2023 OFFICIAL USE ONLY
Source: MVF WEB
Relationship: Owner
Printed Date: 4/23/2023
Claim ID: 20939307
Owner(s) Name Reported Owner Address
HARRAHS CASINO , 00000
Type of Property Reported By Property ID Number
Money Order WELLS FARGO & COMPANY 977497166
Cash Reported Shares Reported Name of Security Reported
$1,000.00
Owner(s) Name Reported Owner Address
CHUMASH CASINO , 3400 EAST HIGHWAY 246, SANTA YNEZ, CA 93460
Type of Property Reported By Property ID Number
Refunds Due CUMMINS ALLISON CORP 979487178
Cash Reported Shares Reported Name of Security Reported
$568.51
Owner(s) Name Reported Owner Address
GLOBAL CASINO MARKETING 5309 VIA CAPOTE, NEWBERRY PARK, CA 91320
Type of Property Reported By Property ID Number
Utility Deposits VERIZON CALIFORNIA INC 979788189
Cash Reported Shares Reported Name of Security Reported
$53.42
Owner(s) Name Reported Owner Address
CASINO VICTORIA C 3500 BUENA VISTA DR, SACRAMENTO, CA 95864
Type of Property Reported By Property ID Number
Savings Accounts GOLDEN 1 CREDIT UNION 981610133
Cash Reported Shares Reported Name of Security Reported
$234.93
Owner(s) Name Reported Owner Address
HAWAIIAN GARDENS CASINO , 00000
Type of Property Reported By Property ID Number
Money Order WELLS FARGO & COMPANY 981953935
Cash Reported Shares Reported Name of Security Reported
$1,000.00
Owner(s) Name Reported Owner Address
GOLDEN ACORN CASINO ATTN: ACCOUNTS PAYABLE, 0, CAMPO, CA 91906
Type of Property Reported By Property ID Number
Credit Balance- Accts Rec TRI-ED DISTRIBUTION INC. 982224190
Cash Reported Shares Reported Name of Security Reported
$50.60
Unclaimed Property Division
MAILING ADDRESS P.O. Box 942850, Sacramento, CA 94250-5873
10600 White Rock Road, Rancho Cordova, CA 95670
(800) 992-4647 (Nationwide) or (916) 323-2827 (Outside of US) Page 2 of 8
Initiated Date: 4/23/2023 OFFICIAL USE ONLY
Source: MVF WEB
Relationship: Owner
Printed Date: 4/23/2023
Claim ID: 20939307
Owner(s) Name Reported Owner Address
CHEENEE CASINO 15158 ROSCOE BLVD APT 5, PANORAMA CITY, CA 91402-4551
Type of Property Reported By Property ID Number
Credit Balance- Accts Rec MEDIANEWS GROUP INC. 982344625
Cash Reported Shares Reported Name of Security Reported
$25.00
Owner(s) Name Reported Owner Address
CASINO VICENTE 450 VICENTE ST, SAN FRANCISCO, CA 94116-3054
Type of Property Reported By Property ID Number
Savings Accounts JPMORGAN CHASE BANK N.A. (703) 983546934
Cash Reported Shares Reported Name of Security Reported
$0.66
Owner(s) Name Reported Owner Address
CHUMASH CASINO IN SANTA YNEZ 3400 E HWY 246, SANTA YNEZ, CA 93460-0000
Type of Property Reported By Property ID Number
Credit Balance- Accts Rec GENERAL ELECTRIC COMPANY 984035331
Cash Reported Shares Reported Name of Security Reported
$12.15
Owner(s) Name Reported Owner Address
CHEENEE CASINO 15158 ROSCOE BLVD APT 5, PANORAMA CITY, CA 91402-4551
Type of Property Reported By Property ID Number
Credit Balance- Accts Rec MEDIANEWS GROUP INC. 985872634
Cash Reported Shares Reported Name of Security Reported
$25.00
Owner(s) Name Reported Owner Address
CHUMASH CASINO 3400 E HIGHWAY 246, ACCTS PAYABLE, SANTA YNEZ, CA 93460-9405
Type of Property Reported By Property ID Number
Credit Balance- Accts Rec CDW LLC 986043526
Cash Reported Shares Reported Name of Security Reported
$217.97
Owner(s) Name Reported Owner Address
CASINONEEDS COM 3895 CLAIREMONT DRIVE SUITE 1, SAN DIEGO, CA 92117
Type of Property Reported By Property ID Number
Misc Intangible Property PAYPAL 987267403
Cash Reported Shares Reported Name of Security Reported
$0.67
Unclaimed Property Division
MAILING ADDRESS P.O. Box 942850, Sacramento, CA 94250-5873
10600 White Rock Road, Rancho Cordova, CA 95670
(800) 992-4647 (Nationwide) or (916) 323-2827 (Outside of US) Page 3 of 8
Initiated Date: 4/23/2023 OFFICIAL USE ONLY
Source: MVF WEB
Relationship: Owner
Printed Date: 4/23/2023
Claim ID: 20939307
Owner(s) Name Reported Owner Address
GOLDEN ACORN CASINO TRAVEL CENTER 1800 GOLDEN ACORN WAY, CAMPO, CA 91906
Type of Property Reported By Property ID Number
Refunds Due HIBU INC. 987400100
Cash Reported Shares Reported Name of Security Reported
$21.09
Owner(s) Name Reported Owner Address
CENTRAL COAST CASINO 359 W GRAND AVE, GROVER BEACH, CA 93433
Type of Property Reported By Property ID Number
Dividends STATE COMP INSURANCE FUND 989733876
Cash Reported Shares Reported Name of Security Reported
$762.68
Owner(s) Name Reported Owner Address
BLUE LAKE CASINO ALICES 777 CASINO WAY, BLUE LAKE, CA 95525-0000
Type of Property Reported By Property ID Number
Discounts Due NATIONAL PURCHASING CORPORATION 991395460
Cash Reported Shares Reported Name of Security Reported
$68.84
Owner(s) Name Reported Owner Address
BLUE LAKE CASINO ALICES 777 CASINO WAY, BLUE LAKE, CA 95525-0000
Type of Property Reported By Property ID Number
Discounts Due NATIONAL PURCHASING CORPORATION 991395461
Cash Reported Shares Reported Name of Security Reported
$63.53
Owner(s) Name Reported Owner Address
CASINO VICTORIA C 3129 VIA GRANDE, SACRAMENTO, CA 95825-2036
Type of Property Reported By Property ID Number
Credit Balance- Accts Rec NORDSTROM FSB 992370105
Cash Reported Shares Reported Name of Security Reported
$74.86
Owner(s) Name Reported Owner Address
GOLD COUNTRY CASINO 4020 OLIVE HIGHWAY, OROVILLE, CA 95966-5527
Type of Property Reported By Property ID Number
Credit Balance- Accts Rec AMERICAN HOTEL REGISTER COMPANY 992828541
Cash Reported Shares Reported Name of Security Reported
$2.17
Unclaimed Property Division
MAILING ADDRESS P.O. Box 942850, Sacramento, CA 94250-5873
10600 White Rock Road, Rancho Cordova, CA 95670
(800) 992-4647 (Nationwide) or (916) 323-2827 (Outside of US) Page 4 of 8
Initiated Date: 4/23/2023 OFFICIAL USE ONLY
Source: MVF WEB
Relationship: Owner
Printed Date: 4/23/2023
Claim ID: 20939307
Owner(s) Name Reported Owner Address
BLUE LAKE CASINO UNKNOWN, UNKNOWN, 00000
Type of Property Reported By Property ID Number
Unidentified Deposit BANK OF AMERICA - CALIFORNIA 994636157
Cash Reported Shares Reported Name of Security Reported
$1,000.00
Owner(s) Name Reported Owner Address
GOLDEN WEST CASINO 1001 S UNION AVE, BAKERSFIELD, CA 93307
Type of Property Reported By Property ID Number
Credit Balance- Accts Rec THE COCA-COLA COMPANY 995250304
Cash Reported Shares Reported Name of Security Reported
$0.01
Owner(s) Name Reported Owner Address
CHUKCHANSI GOLD RESORT & CASINO 711 LUCKY LN, COARSEGOLD, CA 93614-8206
Type of Property Reported By Property ID Number
Credit Balance- Accts Rec FASTENAL COMPANY 995975678
Cash Reported Shares Reported Name of Security Reported
$45.15
Owner(s) Name Reported Owner Address
CHUMASH CASINO 3400 E HIGHWAY 246, SANTA YNEZ, CA 93460
Type of Property Reported By Property ID Number
Credit Balance- Accts Rec BBU INC. & SUBSIDIARIES 996403515
Cash Reported Shares Reported Name of Security Reported
$57.84
Owner(s) Name Reported Owner Address
GARDEN CITY CASINO 360 S. SARATOGA AVENUE, SAN JOSE, CA 95129
Type of Property Reported By Property ID Number
Accounts Payable STAPLES INC 996442981
Cash Reported Shares Reported Name of Security Reported
$285.02
Owner(s) Name Reported Owner Address
HA07082013CACHE CREEK CASINO TRIBAL 11246 COUNTY RD 86, ESPARTO, CA 95627
FIRS
Type of Property Reported By Property ID Number
Refunds Due SUTTER MEDICAL FOUNDATION 996782394
Cash Reported Shares Reported Name of Security Reported
$5.00
Unclaimed Property Division
MAILING ADDRESS P.O. Box 942850, Sacramento, CA 94250-5873
10600 White Rock Road, Rancho Cordova, CA 95670
(800) 992-4647 (Nationwide) or (916) 323-2827 (Outside of US) Page 5 of 8
Initiated Date: 4/23/2023 OFFICIAL USE ONLY
Source: MVF WEB
Relationship: Owner
Printed Date: 4/23/2023
Claim ID: 20939307
Owner(s) Name Reported Owner Address
CASINOS & CRUISES 10153 RIVERSIDE DR, TOLUCA, CA 91602
Type of Property Reported By Property ID Number
Commissions HILTON DOMESTIC OPERATING COMPANY 996826938
INC
Cash Reported Shares Reported Name of Security Reported
$29.19
Owner(s) Name Reported Owner Address
CASINOITEMS COM 23362 MADERO ROAD, SUITE D, MISSION VIEJO, CA 92691
Type of Property Reported By Property ID Number
Credit Balance- Accts Rec GOOGLE LLC 997937884
Cash Reported Shares Reported Name of Security Reported
$0.21
Owner(s) Name Reported Owner Address
BLUE LAKE CASINO ALICES 777 CASINO WAY, BLUE LAKE, CA 95525
Type of Property Reported By Property ID Number
Discounts Due NATIONAL PURCHASING CORPORATION 998486381
Cash Reported Shares Reported Name of Security Reported
$58.61
Owner(s) Name Reported Owner Address
BLUE LAKE CASINO ALICES 777 CASINO WAY, BLUE LAKE, CA 95525
Type of Property Reported By Property ID Number
Discounts Due NATIONAL PURCHASING CORPORATION 998486382
Cash Reported Shares Reported Name of Security Reported
$64.17
Unclaimed Property Division
MAILING ADDRESS P.O. Box 942850, Sacramento, CA 94250-5873
10600 White Rock Road, Rancho Cordova, CA 95670
(800) 992-4647 (Nationwide) or (916) 323-2827 (Outside of US) Page 6 of 8
Initiated Date: 4/23/2023 OFFICIAL USE ONLY
Source: MVF WEB
Relationship: Owner
Printed Date: 4/23/2023
Claim ID: 20939307
Claim Affirmation Form (continued)
Section B - Required Documentation
Please see the attached "Documentation Required for Property Owner Claims"
Section C - Claimant Information
Each of the undersigned claimants certifies, under penalty of perjury, that the claimant has read the claim and knows the contents thereof and that the
claimant is the owner of said claim and the person entitled to receive the money and property set forth in said claim.
Each claimant agrees to indemnify and hold harmless the State, its officers, and employees from any loss resulting from the payment of said claim.
EACH CLAIMANT MUST SIGN THIS AFFIRMATION OR THE CLAIM WILL BE RETURNED.
For claims filed for a business, the authorized owner's signature is required. For claims filed for an estate or trust, the signature of the executor,
administrator or trustee is required.
Claimant Information
CURRENT LEGAL LAST NAME OR BUSINESS NAME CURRENT LEGAL FIRST NAME MIDDLE SSN OR FEDERAL TAX ID
Soto Shaun
CURRENT MAILING ADDRESS CITY STATE/PROVINCE ZIP CODE COUNTRY
3461 mines rd Livermore CA 94550
DRIVER LICENSE NUMBER DATE OF BIRTH EMAIL ADDRESS
shunsoto@gmail.com
DAYTIME PHONE SIGNATURE DATE
(925) 352-1464
Additional Claimant Information (if Applicable)
CURRENT LEGAL LAST NAME OR BUSINESS NAME CURRENT LEGAL FIRST NAME MIDDLE SSN OR FEDERAL TAX ID
CURRENT MAILING ADDRESS CITY STATE/PROVINCE ZIP CODE COUNTRY
DRIVER LICENSE NUMBER DATE OF BIRTH EMAIL ADDRESS
DAYTIME PHONE SIGNATURE DATE
Section D - Affidavit Notarization
(YOUR SIGNATURE(S) MUST BE NOTARIZED IF THE CLAIM AMOUNT IS $1,000 OR GREATER.
ALL CLAIMS FOR SECURITIES OR SAFE DEPOSIT BOXES MUST BE NOTARIZED.)
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this
certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of ____________________________________, County of __________________________
Subscribed and sworn to (or affirmed) before me on this ____day of________________, 20___ by
_____________________________________, proved to me on the basis of satisfactory evidence to
be the person(s) who appeared before me.
Signature____________________________________ (seal)
PRIVACY NOTIFICATION
The Information Practices Act of 1977 and the Federal Privacy Act require this Bureau to inform you that your Social Security number
and other documents are requested for property identification and processing of your claim.
You have the right to view your records at this office by writing :
Division Chief, Unclaimed Property Division, P.O. Box 942850, Sacramento, CA 94250 - 5873.
Unclaimed Property Division
MAILING ADDRESS P.O. Box 942850, Sacramento, CA 94250-5873
10600 White Rock Road, Rancho Cordova, CA 95670
(800) 992-4647 (Nationwide) or (916) 323-2827 (Outside of US) Page 7 of 8
Initiated Date: 4/23/2023 OFFICIAL USE ONLY
Source: MVF WEB
Relationship: Owner Controller Malia M. Cohen
Printed Date: 4/23/2023 California State Controller's office
Unclaimed Property Division Claim ID: 20939307
PROPERTY OWNER CLAIM
FILING INSTRUCTIONS AND REQUESTED DOCUMENTATION
To claim property reported in your name, please provide the information requested in the property owner filing instructions
found here:
Filing Instructions for A Property Owner
The link above provides detailed information on what documentation we need in order for us to verify your ownership of the property.
Having the same name as that on an account does not necessarily mean you are the owner. There are many people who share the same
name. To make sure our office is able to verify that you are the rightful owner, you must provide all the required documentation.
Although the Social Security Number (SSN) is our primary method of verification, we sometimes cannot verify a claim based on the
SSN because the company reporting the property did not provide an SSN when transferring the property to us. In these cases, we will
need the additional documentation listed on the filing instructions to verify your claim. If you have these documents available, please
submit them when you file your claim to ensure the processing of your claim is not delayed.
Unclaimed Property Division
MAILING ADDRESS P.O. Box 942850, Sacramento, CA 94250-5873
10600 White Rock Road, Rancho Cordova, CA 95670
REV 1/2/2023 (800) 992-4647 (Nationwide) or (916) 323-2827 (Outside of US) Page 8 of 8
