53-120

(Rev.11-09/6)
PRINT YOUR CLAIM
Texas Unclaimed Property
Original Owner Claim Form Claim number
Under Ch. 559, Government Code, you are entitled to review, request and correct information we have on file 11351980
about you, with limited exceptions in accordance with Ch. 552, Government Code. To request information for
review or to request error correction, contact us at the address or phone number listed on this form.

max mills
#812
*11351980*
14365 cornerstone village dr Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
houston, TX 77014 Unclaimed Property Claims Section
P.O. Box 12046
Austin, TX 78711-2046
PLEASE SEE THE INSTRUCTIONS BEFORE COMPLETING THIS FORM

CLAIMANT INFORMATION

Name (Last) (First) (Middle) (Maiden) Social Security number

mills max ray 466371873
Additional owner (Last) (First) (Middle) (Maiden) Social Security number

Current mailing address Daytime phone (Area code and number)

#812 14365 cornerstone village dr (832)371-5854
City State ZIP code
houston TX 77014
E-mail address FAX (Area code and number)
trereal100@yahoo.com ()-
The named Claimant hereby certifies that this claim for property presumed abandoned is valid and just, that all statements herein are true and correct,
and that upon payment of this claim said Claimant will indemnify and hold harmless the State of Texas, the Comptroller and its employees from any
damages, claims, or losses of any kind resulting from the payment of the property to the Claimant.
Claimant's signature Date Would you like to contribute all or part of your
claim to the Match the Promise Foundation?
Additional owner's signature Date
✔YES ✔NO %

PLEASE COMPLETE, SIGN, AND RETURN THE CLAIM FORM WITH A COPY OF YOUR IDENTIFICATION

EVEN IF YOU ARE UNABLE TO PROVIDE ALL THE REQUESTED DOCUMENTS.

1 PROPERTY INFORMATION --- FOR OFFICE USE ONLY

Reported property owner Reported additional owner
MAX MILLS
Reported property address
700 DUNSON GLEN DR HOUSTON, TX 77090
Property type Description
Wages, Payroll or Salary
Reporting company Last active date Claimed amount
ARAMARK CORP 2009 704.81

PROPERTY INFORMATION --- FOR OFFICE USE ONLY

Reported property owner Reported additional owner

Reported property address

Property type Description

Reporting company Last active date Claimed amount

--- FOR INTERNAL USE ONLY ---

Issued to Claim number
11351980
Approved by Date Number of properties Total amount of claim
1 704.81
If you have any questions regarding Unclaimed Property, call (800) 321-2274. The Austin number is (512) 463-3040.
Instructions for Claim Number: 11351980

ORIGINAL OWNER CLAIM

The claimant must be 18 or older to file.
Please provide the following:
1.Copy of claimant's photo identification (e.g. driver's license, state identification
card, passport, etc.)
2.Proof of Social Security Number (SSN) for the Reported Property Owner and Reported
Additional Owner (see the Property Information box on your claim), for each property
on your claim
3.Documentation from your own files proving that the Reported Property Owner lived at
the Reported Property Address (see the Property Information box), for each property
on your claim
Other documentation requested for each property below:
- Property # 1
.none