TAILINGS - Uncashed check claim form November 20 2025 adv due by November 20 2026

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TOWN OF CANTON
                               801 WASHINGTON STREET
                                  CANTON, MA 02021

                                UNCASHED CHECK CLAIM FORM

Please make a copy of the claim form for your records and return the completed form to the address
below. If you have any questions please call Ellen Jones at 781-575-6610.

              Town of Canton
              Attn: Finance Director
              801 Washington Street
              Canton, MA 02021

Claimant must sign below. Fraud or misrepresentation may result in criminal prosecution.

I understand that the Town of Canton advertised in the Canton Citizen on November 20, 2025 a listing
of unclaimed checks. By completion of this form in its entirety I make claim to the uncashed check
listed below and understand that the date to make a claim to this uncashed check must be made by
November 20, 2026 (one year from date of legal ad).



PLEASE SIGN BELOW TO ACKNOWLEDGE CLAIM TO THE CHECK(S).


Name__________________________________________________________________________

Address________________________________________________________________________

City, State, Zip Code______________________________________________________________

Last 4 digits of Federal Tax ID / Social Security Number __________________________________

Phone_____________________ Email_______________________________________________

SIGNED__________________________________________ DATE________________________

       Check #              Check Date           Check Amount

    ____________           ____________          _____________

    ____________           ____________          _____________

    ____________           ____________          _____________