Form 600b - Claim For Unclaimed Property - Owner Deceased

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Arizona Department of Revenue

ARIZONA FORM

600B

Claim for Unclaimed Property - Owner Deceased

For assistance in the Phoenix area: (602) 364-0380 or

Outside the Phoenix area toll free: (877) 492-9957

Mail To: Arizona Department of Revenue ● Unclaimed Property Unit ● PO Box 29026 ● Phoenix AZ 85038-9026

1. Original Owner’s Name:

2. Property ID #:

3. Original Owner’s Social Security or Tax Identiﬁ cation Number

4. Original Owner’s Address as reported by holder:

5. Mailing address (Where you would like correspondence, including payment sent)

Number and Street, Rural Route, and Apartment / Suite Number

City

State

Zip Code

In order to initiate a claim for this property the following information must be included:

You must provide a copy of the original owner’s death certiﬁ cate

You must provide proof of the original owner’s social security number

You must provide proof that the original owner lived or received mail at the address listed above in item #4

You must provide a clear copy of your ofﬁ cial photo identiﬁ cation or have the claim form notarized below.

Answer each question below and provide the documentation required for each question answered yes.

Yes

No - Probate is open for this estate, or if closed, has it been closed for less than one year?

If the answer is yes, the personal representative for this estate must apply by submitting a claim form, and Letters of Ofﬁ ce certiﬁ ed in the last 60 days.

Yes

No - Probate was never initiated or has been closed for longer than a year and the original owner did have a Will?

If yes, the Devisees named in the Will may apply by submitting a copy of the Will, and the Trust if ine is mentioned in the Will, and the decree of distribution if

one exists.

Yes

No - Probate was never initiated and the original did not have a Will?

If yes, the heirs of the original owner may apply by submitting a complete Afﬁ davit of Collection of Personal Property.

Declarations: I swear under penalty of perjury that statements I made on this claim form and any other statements that I made or will make during the claims process

are true and correct to the best of my knowledge. Photocopies I have provided or will provide are the same as the original document. I understand that additional

evidence may be needed to process my claim and that the claims processing staff may contact me in that case. I agree that if for any reason it is found that I am

not entitled to this payment or I receive a duplicate payment, I will return the funds to the Arizona Department of Revenue within 15 days.

6. Claimant’s Name

Last Name

i F

t s r

i n I

l a i t

Social Security Number

Telephone Number

7. Signature:

Date:

Subscribed and Afﬁ rmed before me by: