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Affidavit to Claim an Uncashed Check

This notice was sent because our records indicate your individual income tax refund check was not cashed. Check the box that applies to you, sign the form and return it to the address on the notice.

If you do not return this affidavit, these funds will be turned over to the Unclaimed Property Division on or about September 1st.  After September 1st you must contact the Unclaimed Property Division to claim your funds.