Form 600 - Claim For Unclaimed Property
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1Arizona Department of Revenue
For Offi cal Use Only
ARIZONA FORM
600
Property ID#
Claim for Unclaimed Property
CLM
AR
DATE
ID
DATE
APPRVD
DATE
Owners of Account:
Property ID #
Address as it appears on the account:
Please attach a copy of documentation that shows the owner’s name with the following address (i.e. tax return, W2 form,
bank statement, billing statement etc.)
Please fi ll in the blanks below:
Claimant or name of person fi ling claim
Social Security Number/Tax ID
Co-claimant
Social Security Number/Tax ID
Current mailing address (Address to which you want check sent)
Please mark one of the following that best describes you:
1.
Are you the owner/owners listed on the fi rst line of this document? If you answered yes
YES
please attach photocopies of two different forms of identifi cation for yourself and co-claimant.
See below for acceptable forms of identifi cation.
2.
Are you the heir or surviving spouse of the owner/owners of this account? If you answered yes
YES
please attach copy of death certifi cate and Will, obituary or notarized list of surviving heirs with
their addresses. If you answered yes please attach photocopies of two different forms of
identifi cation for yourself and co-claimant. See below for acceptable forms of identifi cation.
3.
Are you the guardian, executor or administrator of or for the owner/owners of this account? If you
YES
answer yes please attach copy of legal document supporting such authority (i.e. power of attorney,
court document, birth certifi cate for owner if the owner is a minor). If you answered yes please attach
photocopies of two different forms of identifi cation for yourself and co-claimant. See below for
acceptable forms of identifi cation.
YES
4.
Are you the offi cer or other person authorized to claim on behalf of the business entity? If you
answered yes please attach a copy of corporate resolution or other document verifying your
authority (i.e. transaction privilege tax license, partnership agreement, proof of DBA).
Acceptable forms of identifi cation: Photocopy of two of the following items: driver’s license,
military ID, passport, social security card, voter registration, etc. At least one form submitted must be a picture ID.
Verifi cation of social security number may be required.
Disclaimer: 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.
Signature of person fi ling claim
Telephone Number
Date
Signature of Co-claimant (if any)
Telephone Number
Date
MAIL TO:
Arizona Department of Revenue
Unclaimed Property
PO Box 29026
Phoenix AZ 85038-9026
ADOR 17-2002 (8/03)
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