Figure: 7 TAC §3.35(e)
REPORT OF DEFACED OR ALTERED ROUTING NUMBER ON SAFE DEPOSIT BOX KEY
Instructions: Complete the information below and submit the original report to Department of Public Safety, Attn: Criminal Law Enforcement, Box 4087, Austin, Texas 78773-0001, no later than 10 days after the defaced or altered key is used to access the box. Retain one copy for your files for a period of three years.
FINANCIAL INSTITUTION INFORMATION
| Name of financial institution | ______________________________ |
| Address of safe deposit box facility | ______________________________ |
| ______________________________ | |
| Name and title of contact person at facility | ______________________________ |
| Area code and phone number of facility | ______________________________ |
| Routing number and branch designation (if any) | ______________________________ |
INCIDENT INFORMATION
| Customer name | ______________________________ |
| Date customer presented defaced or altered key | ______________________________ |
| Description of problem with key | ______________________________ |
| ______________________________ | |
| ______________________________ | |
| ______________________________ |
Date of report: ____________________
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