USAS
Athletic

Voided Check	Check
Date	Number

Unclaimed Check
Vendor	Amount

Bath Local Schools Unclaimed Funds

Reissued Void	Check Date          Number

Reissued Check Amount

Reissued Check Date

09/17/2021	95584 KYLIE LONGMEIER	$	12.31 001-1890	x	5/16/23 10/31/2021	95822 KATIE WIREMAN	$	40.00 001-1710	x	5/16/23 10/31/2021	95807 KELLY BURKE	$	10.00 009-1710	x	5/16/23 02/22/2022	96298 TIMOTHY CHEESEMAN	$	20.00 009-1710	x	5/16/23 03/15/2022	96407 ALEXIS SELLERS	$	15.00 009-1710	x	5/16/23 05/17/2022	96720 LEXI BITTERS	$           8.00 018-1890	x	5/16/23 05/23/2022	96778 KRISTY WEBER	$	30.80 006-1512	x	5/16/23 05/23/2022	96777 KARIE OLDIGES	$       176.75 006-1512	x	5/16/23 06/17/2022	96918 CORINA ORDONIA	$	15.00 001-2821	x	5/16/23 10/12/2022	97402 BROOKE BARBADAES	$	25.00 300-1630 $10 /009-1710 $15	x	5/16/23 10/12/2022	97412 TANNIE CRIDER	$	35.00 009-1710	x	5/16/23 10/12/2022	97404 DEANNAH HUGHES	$	15.00 009-1710	x	5/16/23 10/28/2022	97585 HEIDI POPE	$	46.00 009-1710	x	5/16/23 10/28/2022	97588 KYLA HOLLAR	$	58.00 009-1710	x	5/16/23
		
$	506.86

Checks that have a yellow highlighted cells are still maintained in the balance of the Unclaimed Funds. After 5 years these unclaimed funds are forfeited with the amounts being released back to the original fund they were expensed from.

Bath Local School District Treasurer's Office 2650 Bible Rd. Lima, OH 45801
419-221-0807 x 6150

Email: thompsonc@bathwildcats.org

UNCLAIMED FUNDS APPLICATION
	
This form must be filled out in its entirety for proof of claim unless the original check is returned to Bath for a replacement check to be reissued to the original name and address on file. Claims are usually processed within 30 business days upon receipt of the proper identification. See instructions below.
	
Unclaimed Funds Instructions
	
1. Personal Identification is required on all claims. ID may include driver's license, state ID, or passport.
2. Proof of Reported Address - Utility bill, bank statement, tax records, mortgage/rent records, or post marked envelope.
3. Unclaimed Funds Application must be signed, notarized, and returned with copies of documentation (1 and 2 above) for reissue.

Claimant Name __________________________________________________________________________________________________

Address 1 _______________________________________________________________________________________________________

Address 2 _______________________________________________________________________________________________________

City State Zip ___________________________________________________________________________________________________

Phone ___________________________

Are you the original owner?
	
_______ Yes _______ No     (If your response is no, please answer the below two questions.)
1. What is your relationship to the owner? ____________________________________________ 2. What is the reason for claiming funds on behalf of the owner?

		

I am claiming a warrant for the following unclaimed funds check:

Date of warrant:_________________	Amount of warrant: __________________________________

Describe reason warrant was not received or was not cashed within 90 days upon receipt:

THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC

Under penalties of perjury, I certify that the information provided on this claim form is true and correct and all supporting documents presented are original or true unaltered copies of the original documents. I also certify that I have a legal equitable interest in the Unclaimed Funds and will indemnify and save harmless Bath Local School District and its employees from any damages, claims, or losses of any kind resulting from payment of the above described funds to claimant.

Claimant's Signature ________________________________________________________________ Date __________________________

Print Name of Claimant _________________________________________________________

Sworn to and subscribed before me the _____Day of ______________Year _______

Notary Signature _________________________________________________	NOTARY SEAL

State of ______________________________ County of __________________

Treasurer's Office Use Only
	
Original Warrant Number _________________________     Reissue Warrant Number ______________________________ Original Issue Date _______________________________     Reissue Warrant Date _________________________________ Warrant Amount _________________________________     Reissue Warrant Amount ______________________________