Skip to Main Content
Loading
Close
Loading
Customers
Education
Efficiency
Water Reliability
About Us
Home
Forms
Unclaimed Money Claim Form
Leave This Blank:
Pursuant to California Government Code 50052, I wish to file a claim for unclaimed funds in the amount of:
Enter amount in the following format: $123.45
Please Check One:
*
I am the PAYEE listed on your website.
I am an HEIR OF THE DECEASED PAYEE listed on your website.
I am an Agent/Officer for the BUSINESS listed on your website.
I am the Agent/Officer for the GOVERNMENT AGENCY listed on your website.
The grounds on which this claim is founded:
First Name:
*
Last Name:
*
Service Address:
Number & Street
Apt./Suite No.
City
State
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Massachusetts
Maryland
Michigan
Minnesota
Mississippi
Missouri
Montana
North Carolina
North Dakota
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
West Virginia
Wisconsin
Wyoming
Washington D.C.
Zipcode
Current Mailing Address:
Number & Street
Apt./Suite No.
City
State
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Massachusetts
Maryland
Michigan
Minnesota
Mississippi
Missouri
Montana
North Carolina
North Dakota
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
West Virginia
Wisconsin
Wyoming
Washington D.C.
Zipcode
Current Telephone Contact Number:
Printed Name of Claimant:
By checking this box, I hereby certify that the above information is true and correct and is being submitted to Western Municipal Water District (District) to substantiate my claim to monies paid to the District. I further certify that I have the authority and right to claim and receive payment of these monies and hereby release the District, its directors, employees, representatives, attorneys, and agents from all liability and further obligation with respect to this claim.
*
I Agree
Please note:
A Social Security Number or Federal ID Number will be required prior to processing payment to the claimant.
* indicates required fields.
Live Edit
Close
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow