Consent Agreement  –  Confirmation of Monies Held, for the Purpose of Retrieval

 

 

To Whom It May Concern:

I/We, ____________________________________________________, the undersigned do hereby grant A and S Capital Group Inc. the right to request and receive any and all information regarding potential or actual funds, property or monies in my/our name or in the name of a relative who I/we qualify as an heir for, limited to:

 

Lost Heirs. Abandoned/condemned Real Property. Medicare & Medicaid refunds.Estate trusts, funds, escrow accounts. Corporate refunds. Monies from lawsuits. Remainders. Unclaimedbank accounts from relatives/ancestors. Unclaimed Tax Refunds. Paid Liens and/or Judgments.  Legal instruments entitling you to monies.

 

Signed – (required) _________________________________________Date _______________________

 

Printed Name – (required)     _____________________________________________________

 

Name on mailing if different from yours, printed –(required) ___________________________________

 

Phone Number for Confirmation – (required)    _____________________________________

 

Current mailing address- required ___________________________________________________

 

Physical (street address) if different than mailing– no po boxes please

 

_____________________________________________________________________________________

 

2nd person – if applicable

 

Signed – required _________________________________________Date ___________________

Printed Name - required ____________________________________

 

Name on mailing if different from yours, printed –required ____________________________________________________

Phone Number for Confirmation – required ______________________________________________

Current mailing address- required ______________________________________________

 

Physical (street address) if different than mailing

– no po boxes please

___________________________________________________

 

This form does not need to be notarized.

 

Please send this consent agreement to:

 

Attn: A and S Capital Group; PO Box 524

Glenn Dale, MD 20769

Or fax to: (240) 993-7800

You can also call with any questions at (301)537-9760