Emerald Financial Services, LLC, an H&R Block Company

Attn: Back Office Operations

PO BOX 30674 Client Check
Salt Lake City, UT 84130 Replacement Request
FAX: 1-866-446-3370
Customer Service 1-888-687-4722
Section A: Claimant Information (Required)
Check Issued As: Refund Transfer Emerald Card Emerald Savings Spruce Spending
Check Check Check
Number: Amount: Issue Date: 02/24/22
Primary
SSN:
Owner Name: Kristilee Murphy 391-17-7816
Joint
SSN:
Owner Name:
Email Daytime
Address: [email protected] Phone Number: 920-750-4551
Mailing Apt:
Address: 512 S. Eagle St.
City: State: Zip Code: 54902
Oshkosh Wisconsin
Section B: Reason For Reissue (Required)
Lost/Stolen/Destroyed Other:
I, We, Claimant(s), under penalty of perjury, hereby state that: The claimant(s) lost possession of the check described above; the claimant(s) is the remitter or
payee of the check; the loss of possession was not the result of a transfer by the claimant(s) or a lawful seizure; and the claimant(s) cannot reasonably obtain
possession of the check because the check was destroyed, its whereabouts cannot be determined, or it is in the wrongful possession of an unknown person or a
person that cannot be found or is not amenable to service of process.
Legal Effect of Claim
This claim is made under the provisions of the Uniform Code, Section 3-312, and the bank’s and claimant’s rights and responsibilities under that law are set forth
in the following paragraphs. This claim becomes enforceable at the later of (i) the time the claim is asserted or (ii) the 90th day following the date of the check. Until
this claim becomes enforceable, it has no legal effect and the bank may pay the check. Payment to a person entitled to enforce the check discharges the bank
from all liability with respect to the check. If this claim becomes enforceable before the check is presented for payment, the bank is not obligated to pay the check.
When this claim becomes enforceable, the bank becomes obligated to pay the amount of the check to the claimant if payment of the check has not already been
made to a person entitled to enforce the check. Payment to the claimant will discharge the bank from all liability with respect to the check. If the bank pays the
amount of the check to a claimant pursuant to the claim and the check is later presented for payment by a person having rights of a holder in due course, the
claimant is obligated to (i) refund the payment to the bank if the check is paid, or (ii) pay the amount of the check to the person having the rights of a holder in due
course if the check is dishonored.
Section C: Disbursement Method (Required)
A check is eligible to be replaced on the 90th day following the date of the check or until the original check is returned, whichever
comes first. Once a check is eligible to be replaced, please allow 5 business days for processing. Updates to the status of your form will
be emailed to the email address provided above.

Emerald Card: Last four of account number: 

8 
9 
9 
1
Spruce Spending: Last four of account number:    
To reissue funds to the account selected above, an account must be on file as of the date below. (1-2 business days for delivery after processing)

Direct Deposit (ACH) (3-5 business days for delivery after processing)
REQUIRED: SUBMIT A PRE-PRINTED VOIDED CHECK or LETTER ON BANK STATIONERY confirming account title,
account number, account type, and routing number. Deposit slips, bank statements, member cards, or starter checks will not be
accepted. If this was a joint account, both owners should be listed on the voided check or letter on bank stationery.
Name(s) on Account
External Account: _____________________________________ Type: Checking Savings
Account Routing
Number: ____________________________________________ Number: ______________________________
 Check (10-14 business days for delivery after processing)
Regular First Class Mail check via USPS to address provided above in Section A. If no address is provided in Section A, then a
check will be mailed to address currently on file.
Section D: Signature (Required)
The claimant signature and joint claimant signature (if applicable) are required below. Per Uniform Commercial Code Section 3-312,
this claim becomes enforceable on the 90th day following the date of the check. By signing, I understand this check will not be issued
according to the disbursement method above until after the 90th day or until the original check is returned, whichever comes first.
07/14/2023
x. ____________________________________ x. ____________________________________
Primary Claimant's Signature Date Joint Claimant's Signature Date

Form 320 Rev. 09/2021