OAR 170-140-0100: Information Required on Property Claim Form

(1) To be complete, the Property Claim form must include the following information: (a) The Claimant’s name: (A) If the Claimant is an individual, the Claimant’s first and last names; or (B) If the Claimant is an Entity, the Entity's legal name. (b) The Claimant’s current mailing address; (c) The Claimant’s current street address, if different than the mailing address; (d) A current and reliable phone number for the Claimant; (e) A current email address for the Claimant, if available; (f) Prior names or alias(es) of the Claimant, if applicable; and (g) Previous address(es) of the Claimant, if applicable. (h) A description of: (A) The nature of the Property being claimed; and (B) The Claimant’s interest in the Property. (2) If the claimed Property is co-owned by another Person, the completed Property Claim form may include the co-Owner’s: (a) Name: (A) If the co-Owner is an individual, the co-Owner’s first and last names; or (B) If the co-Owner is an Entity, the Entity’s legal name. (b) The co-Owner’s current mailing address; (c) The co-Owner’s current street address, if different than the mailing address; (d) A current and reliable phone number for the co-Owner; (e) A current email address for the co-Owner, if available; (f) Prior names or alias(es) of the co-Owner, if applicable; and (g) Previous address(es) of the co-Owner, if applicable. (3) The Property Claim form must include a declaration immediately above the Claimant’s signature and in prominent font as follows: “I declare under penalty of perjury that to the best of my knowledge, information and belief I am entitled to the Property described in this Property Claim form and that the information, records or statements provided in support of this Claim do not contain false or fraudulent information. I further acknowledge that presenting a false claim may give rise to personal liability under the False Claims Act, Oregon Revised Statutes (ORS) 180.750 to 180.785.” (4) If the total value of the Property being claimed is more than $2,500.00, the Claimant’s signature must be notarized. (5) If the Claimant is not the original Owner, then the Claimant must provide a description of the relationship between the Claimant and the original Owner. (6) If the Claimant is the heir or devisee of a deceased Owner, the Claimant must provide a description of the Claimant’s relationship to the deceased Owner. (7) To help expedite the Claim, the Claimant may voluntarily provide the Claimant’s full or partial (i.e., last four digits) Social Security number to the Treasurer. The Treasurer will use the Social Security number to verify the Claimant’s entitlement to the claimed Property and will not disclose Claimant’s Social Security number unless required to do so by law or court order.