Famine in Egypt

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53-120
(Rev.11-09/6)

PRINT YOUR CLAIM
Claim number

Texas Unclaimed Property Original Owner Claim Form
Under Ch. 559, Government Code, you are entitled to review, request and correct information we have on file about you, with limited exceptions in accordance with Ch. 552, Government Code. To request information for review or to request error correction, contact us at the address or phone number listed on this form.

13098281

billy hydrick 535 ernest dr marshall, TX 75670

*13098281*
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS Unclaimed Property Claims Section P.O. Box 12046 Austin, TX 78711-2046 PLEASE SEE THE INSTRUCTIONS BEFORE COMPLETING THIS FORM
CLAIMANT INFORMATION

Name (Last)

(First)

(Middle)

(Maiden)

Social Security number

hydrick
Additional owner (Last) Current mailing address

billy
(First)

bob
(Middle)

na
(Maiden)

455217584
Social Security number Daytime phone (Area code and number)

535 ernest dr
City State

(903)934-8408
ZIP code

marshall
E-mail address

TX

75670
FAX (Area code and number)

billy_hydrick@yahoo.com

()-

The named Claimant hereby certifies that this claim for property presumed abandoned is valid and just, that all statements herein are true and correct, and that upon payment of this claim said Claimant will indemnify and hold harmless the State of Texas, the Comptroller and its employees from any damages, claims, or losses of any kind resulting from the payment of the property to the Claimant. Claimant's signature Additional owner's signature Date Date Would you like to contribute all or part of your claim to the Match the Promise Foundation?

YES

NO

%

PLEASE COMPLETE, SIGN, AND RETURN THE CLAIM FORM WITH A COPY OF YOUR IDENTIFICATION EVEN IF YOU ARE UNABLE TO PROVIDE ALL THE REQUESTED DOCUMENTS.

1
Reported property owner

PROPERTY INFORMATION --- FOR OFFICE USE ONLY

Reported additional owner

BILLY HYDRICK
Reported property address Property type

509 BLOCK ST LOT B MARSHALL, TX 75670
Description

Vendor Checks
AT&T CORP

00214883
Last active date Claimed amount

Reporting company

1997
PROPERTY INFORMATION --- FOR OFFICE USE ONLY

75.00

2
Reported property owner

Reported additional owner

BILLY P HYDRICK
Reported property address Property type

535 ERNEST DR LOT 2 MARSHALL, TX 75670-4607
Description

Refunds/Rebates Due
DISH NETWORK CORP

60774082 REFUNDS REBATES DUE
Last active date Claimed amount

Reporting company

2005
--- FOR INTERNAL USE ONLY ---

279.00
Claim number

Issued to Approved by Date Number of properties

13098281
Total amount of claim

2

354.00

If you have any questions regarding Unclaimed Property, call (800) 321-2274. The Austin number is (512) 463-3040.

Instructions for Claim Number: 13098281

ORIGINAL OWNER CLAIM
The claimant must be 18 or older to file.

State law authorizes a handling fee for certain claims. There will be no fee if your claim is not paid or if your claim is less than $100. The amount of the fee is 1.5% for all claims in excess of $100. If a fee is assessed, it will be deducted from the claim amount at the time of payment.

Please provide the following: 1.Copy of claimant's photo identification (e.g. driver's license, state identification card, passport, etc.) 2.Proof of Social Security Number (SSN) for the Reported Property Owner and Reported Additional Owner (see the Property Information box on your claim), for each property on your claim 3.Documentation from your own files proving that the Reported Property Owner lived at the Reported Property Address (see the Property Information box), for each property on your claim Other documentation requested for each property below: - Property # 1 .none - Property # 2 .none

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