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COMMONWEALTH OF MASSACHUSETTS Department of the State Treasurer Unclaimed Property Division One Ashburton Place 12th Floor Boston MA 02108-1608 617 367-0400 LOST STOCK AFFIDAVIT 1. Being duly sworn under the penalties of perjury I Name state I am of full age and reside at Street City/Town State Postal Code COMPLETE THE FOLLOWING SECTION IF YOU ARE THE ORIGINAL OWNER 2. I have not sold assigned transferred nor pledged lost stock certificate and balance nor given it away nor authorized nor...
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