N.Y. Abandoned Property Law § 503

§ 503. Report of abandoned property. Each payment or delivery of\nabandoned property pursuant to section five hundred two shall be\naccompanied by a written report, affirmed as true and accurate under\npenalty of perjury, in such form as the state comptroller shall\nprescribe, setting forth:\n (a) The name and last known address, if any, of the person appearing\nto be entitled to such abandoned property;\n (b) A description of such abandoned property;\n (c) The number of shares represented or the face amount of the\nsecurity;\n (d) The amount of any principal, dividend, interest or other increment\ndue thereon;\n (e) The date such amount was demandable or payable; and\n (f) Such other identifying information as the state comptroller may\nrequire.\n