Fillable Form 600c - Claim For Unclaimed Property - Business Claim printable pdf download

Form 600c - Claim For Unclaimed Property - Business Claim

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Arizona Department of Revenue

ARIZONA FORM

600C

Claim for Unclaimed Property - Business Claim

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 proof of the tax identiﬁ cation number such as a W-9

You must provide veriﬁ cation of the address listed above in item #4

You must provide a clear copy of claimant’s 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 - This business is/was a sole proprietorship.

If the answer is yes, provide veriﬁ cation of your afﬁ liation with the business such as a business license and a completed Sole Proprietorship Afﬁ davit.

Yes

No - This business is a partnership.

If yes, provide proof that the mailing address in item #4 belongs to one of the partners and a copy of the partnership agreement.

Yes

No - This business is a corporation.

If yes, provide proof that the mailing address in item #4 belongs to the corporation, a completed Power of Attorney, Arizona Form 285 for the person claiming,

indicating in section 4g the authorization to collect unclaimed 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: