Forms & Documents

Indemnification Agreement - Abandoned Property

TOWN OF PLYMOUTH
Office of the Treasurer/Collector
11 Lincoln Street
Plymouth, MA 02360
508-747-1620

Check #___________

Amount __________

Dated: ___________

Our records indicate a check made payable to you, as referenced above, has never been cashed. In order for a replacement check to be issued you will need to certify that you have not cashed or received a reimbursement for the check in question. If the Town finds that a duplicate payment has been issued to you, we reserve the right to collect any funds owed to the Town.

Please sign and return this form to the Office of the Treasurer/Collector as certification that you have not received the funds and are requesting a replacement check.

I, ________________________________ herby certify under pains and penalties of perjury that I have not received the check in question or a reimbursement of the same and I am entitled to receive a replacement check.

____________________________________ ______________________
Signature                                                          Date

Telephone: _______________ Mailing Address:_____________________________

Please allow two weeks for processing a replacement check. Should you have any questions regarding this matter, please do not hesitate to contact the office at 508-747-1620, extension 167 or 168.

Sincerely,

Patricia Meachen
Assistant Treasurer