By clicking the AGREE button below, I certify and verify the following:
i.     I am the person whose name I keyed in;
ii.    All the information I have keyed in is my information, true and accurate;
iii.    I believe that I am the true owner of the property(ies) for which I am claiming and that this is a valid claim;
iv.   Upon payment of this claim, I agree to, and shall indemnify, save harmless, and defend the State of Nevada, its agents, officers and employees, the Nevada State Treasurer, and the Nevada Abandoned Property Trust Account, from any loss, claim, or liability arising out of or in connection with the payment of this claim; and that (v.) it is agreed that any and all transactions entered into herein by me in connection with this claim for unclaimed property will be subject to
     a. the Uniform Electronic Transaction Act (UETA) to the extent applicable under Chapter 719 of the Nevada Revised Statuses, and
     b. the federal Electronic Signatures in Global and National Commerce Act (E-SIGN), with the effect that affirmatively keying in my name indicates my intention that such affirmative act shall be deemed to be a binding electronic signature.


Signature must match the following:

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