Complete this extension request and submit to obtain an automatic extension of time to file your Annual Report of Unclaimed Funds beyond the due date of November 1 (May 1 for Life Insurance Businesses).

*** Any additional requests for an extension must be made in writing prior to the expiration of the original extension period. A request for a second extension to the reporting deadline will be granted only for good cause shown and at the discretion of the Department of Commerce, Division of Unclaimed Funds per R.C. 169.03(C). Any questions should be directed to the Division’s Compliance Section at: (614) 466-4433 or (877) 644-6823. ***

NOTICE: Life Insurance Businesses extensions are NOT permitted at this time.

Report Year ( 2019 )

HOLDER INFORMATION

Name

FEIN

Address 1

Address 2

Address 3

City     State
--Select State--
   

Zip Code

CONTACT INFORMATION

Name

Title

Phone

Email         
Re-type Email

ADDITIONAL INFORMATION

NOTICE: Only ONE EXTENSION to the unclaimed funds reporting deadline is permitted each reporting year for all holder types.
Holder Type NOTICE: Life Insurance Businesses extensions are NOT permitted at this time.

I request an automatic extension of

Please Select Holder Type and Extension Period