I have not seen a model notice and the requirement, as written, is at best very confusing. Here is what I am thinking of using:
We are required by law to notify you that your property stored in your safe deposit box, or the proceeds from sale of such property, may be transferred to the appropriate state* upon the running of the time specified by state law** from the date the lease or rental period on the safe deposit box or repository expired, or from the date of termination of any agreement because of which the box or other repository was furnished to the owner without cost, whichever is earlier.
* The “appropriate state” depends on the box renter’s address and where they live. For California residents with a California address, this will normally be the state of California.
** The “time specified by state law” varies by state. For property subject to escheat to the State of California, the time period is three years.
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My opinions are not legal advice and are worth what you paid for them.