11/24/2019 Pennsylvania Treasury - Bureau of Unclaimed Property

Joseph M. Torsella Bureau of Unclaimed Property

State Treasurer P.O. Box 1837
Harrisburg, PA 17105-1837
1 (800) 222-2046

You may be entitled to money from the Pennsylvania Treasury Department’s Bureau of Unclaimed Property -- we want to help you
claim what's yours!

Unclaimed property includes things like abandoned bank accounts, forgotten stocks, uncashed checks, certificates of deposit, life
insurance policies, safe deposit box contents, and recovered stolen property.

It's easy for property to become unclaimed -- it happens all the time! Maybe you've moved, and your insurance company has been
unable to locate you. Or you forgot to cash an old rebate check. Whatever the case, your money belongs in your wallet!

Financial assets that have become dormant are considered to be unclaimed property. Dormancy in
most cases is considered to be three years, although there are some exceptions.

You have downloaded our claim form. It lists the property that may be yours. In order to claim that property, please follow the
instructions below carefully. Original documents will not be returned to you. To prevent unnecessary delays in processing your claim,
please make sure that any photocopies of documentation are readable, black and white copies on standard size, white paper. Because
all of your documentation is imaged upon receipt, it is advisable that you do not use a highlighter, staples or tape on any of the
documents.

In order to claim the property, please complete the following steps:

If you are the property owner:

Complete and sign the Claim Form.

Each owner listed in Box A of the Property Description page must sign the enclosed forms. If an owner or beneficiary is
deceased, include a certified copy of the death certificate.
If the name of the owner listed in Box A of the Property Description page has changed, provide documentation of the name
change.
If you are in possession of the original property that is listed in Box F of the Property Description page, such as an uncashed
check or stock certificate, please return it along with your form(s).
If you have a legal representative, such as an attorney, power of attorney, trustee or guardian, provide documentation
authorizing the representative to act on your behalf and to receive information regarding the claim.
The custodian must complete and sign the enclosed form(s). If the custodian of the account is deceased, the parent or guardian
of the minor must determine who may claim the property. A certified copy of the death certificate for the custodian must be
provided.
If an address is listed in Box B of the Property Description section, provide proof of residing at that reported address.

Additional documentation may be requested to prove you are the rightful owner.

Pennsylvania law requires the State Treasurer to sell all stocks, bonds, and other negotiable financial instruments upon receipt of such
items. Therefore, in such cases, you will not receive the actual physical certificate but will instead receive a check representing the net
value of the shares as of the date of liquidation.

Return your claim forms to the Pennsylvania Treasury Department, Bureau of Unclaimed Property, P.O. Box 1837,
Harrisburg, PA 17105-1837. Our Return Team stands ready to assist you at 1-800-222-2046.

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11/24/2019 Pennsylvania Treasury - Bureau of Unclaimed Property

Claim ID: 79908848

Joseph M. Torsella
State Treasurer

Property ID's: 18413822, 27241218

PROPERTY DESCRIPTION
Property / Holder Information(s) Property Id: 18413822
(A) Original Owner's Name (B) Original Owner's Address as Reported
RUSSO, DAMIAN 2709 Wharton St
Philadelphia, PA 19146-0000
(C) Holder Reporting Funds (D) Last Transaction Date
Comcast Of Willow Grove Inc 02/17/2011
(F) Type of Funds Reported (G) Certificate, Policy or Check Number
Refunds / Rebates

Property / Holder Information(s) Property Id: 27241218

(A) Original Owner's Name (B) Original Owner's Address as Reported
RUSSO, DAMIAN 2709 Wharton Street
Philadelphia, PA 19146
(C) Holder Reporting Funds (D) Last Transaction Date
Reconstructive Orthopaedic Associates Ii Pc 07/24/2015
(F) Type of Funds Reported (G) Certificate, Policy or Check Number
Credit Balances

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11/24/2019 Pennsylvania Treasury - Bureau of Unclaimed Property

Joseph M. Torsella
State Treasurer

Claim ID: 79908848

Property ID's: 18413822, 27241218

OWNER CLAIM FORM

CLAIMANT INFORMATION

YOUR NAME(S): Damian Russo

SOCIAL SECURITY NUMBER: 204566245 DATE OF BIRTH: 03/13/1963

CURRENT MAILING ADDRESS: 2709 Wharton Street,

CITY: Philadelphia STATE: RI ZIP: 19146

PHONE NUMBER: (215) -22 - 7-29 27 EMAIL ADDRESS: 2709spinnersend@gmail.com

Property Id Property Description Holder

18413822 Refunds / Rebates Comcast Of Willow Grove Inc
27241218 Credit Balances Reconstructive Orthopaedic Associates Ii Pc

BEING first duly sworn, the above claimant(s) deposes and represents as follows:

THAT I/we am/are submitting a claim for unclaimed property held by the Pennsylvania Treasury Department ("Treasury");

THAT I/we am/are entitled to the above claimed property, presently under the custodial control of Treasury.

In consideration of the receipt of the above-mentioned property ("property"), I/we agree to indemnify Treasury and hold Treasury
and its employees and representatives harmless against any and all claims, costs, expenses (including reasonable attorney fees) or any
other loss arising out of the receipt, care, and delivery of the property to me/us, or arising out of Treasury's refusal to deliver the
property to any other persons or entities who may, in the future, be determined to be the rightful owner of the property.

THAT I/we agree that this Agreement shall be construed in accordance with the laws of the Commonwealth of Pennsylvania; and

THAT I/we hereby acknowledge and understand that any false information and/or documentation supplied with the claim, which
I/we do not believe to be true, will subject me/us to prosecution and penalties under 18 Pa. C.S.§4904, (relating to unsworn
falsification to authorities).

X _________________________________________ X_________________________________________
Signature of Claimant Signature of Additional Claimant(s)

IMPORTANT INFORMATION REGARDING YOUR PAYMENT.

The Pennsylvania Treasury Department is responsible for custodial care of unclaimed property. It is proactive of Treasury not to
allow the forwarding of checks through the United States Postal Service, even if you have a mail forward notice filed with the Post
Office. If you have moved since initially filing your claim (in other words, if your mailing address is different from the address you
provided at the time of filing your claim), please contact us at 1-800-222-2046 to provide your updated mailing address directly.

Failure to contact Treasury with your current address may result in delays in receiving your unclaimed property.

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11/24/2019 Pennsylvania Treasury - Bureau of Unclaimed Property

THIRD PARTY INFORMATION

State law limits the fee a third party can charge an owner for the recovery of unclaimed property to 15 percent of the
property value. Please contact the Bureau of Unclaimed Property at 1-800-222-2046 with any additional questions.

** If You Paid A Fee To Claim Your Property, Please Complete The Following**

The Pennsylvania Treasury Department does not charge a fee to claim or recover unclaimed property. Third parties who assist with
the recovery of unclaimed property are subject to requirements set forth under section 1301.11 of Pennsylvania's Unclaimed Property
Act. They must disclose the nature and value of the property as well as where it is being held. (Pennsylvania Treasury Department).
The fee a third party can charge to assist with the recovery of property cannot exceed 15% of the total value of the property.

Was/Is a third party involved in providing this claim form to you/the claimant or assisting with the claim in any way? If so, please
state the amount of such fee or payment.

_______Yes _______No $___________Please specify amount of fee / payment.

Third Party Information:

Name: ____________________________________________________________________________________

Address: __________________________________________________________________________________

Phone Number: _____________________________________________________________________________

Registration Number: ________________________________________________________________________

Email Address: _____________________________________________________________________________

Please be advised that, effective January 12, 2015, a person may not engage in and receive compensation for any activity for
the purpose of locating or assisting in the recovery of unclaimed property on behalf of another, without first obtaining a
Certificate of Registration from the State Treasurer, which includes a registration number. For more information, visit
www.patreasury.gov.

Please complete this two-page document in its entirety and return both pages to our office

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