Form Ador 25-000 - Tax Clearance Application Form - Arizona Department Of Revenue

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Arizona Department of Revenue
Tax Clearance Application
Application Information
1.
(
)
Applicant
Phone Number
Address
City
State
Zip Code
2.
Tax Clearance Purpose (Check Only One Box)
q
Dissolution of Corporation **
Certificate of Compliance for
q
Dissolution or Withdrawal
Withdrawal from Arizona **
q
Sale of Business
q
Personal
Letter of Good Standing
q
Residency
q
Other
3.
Application Type
(Check Only One Box and Provide Tax Identification Number(s))
q
Corporation
-
Federal Employer ID number
q
S Corporation
OR
q
Partnership
-
-
AZ Transaction Privilege License Number
q
Tax Exempt Organization
OR
q
Limited Liability Company
-
-
AZ Withholding Tax License Number
q
Limited Liability Partnership
q
Estate
-
-
Social Security Number
q
Trust
OR
OR
OR
OR
OR
OR
OR
q
-
-
Individual
AZ Transaction Privilege License Number
OR
-
-
AZ Withholding Tax License Number
4.
Signature
Print Name
Print Specific Title
(Corporate Officer, Partner, Individual)
Signature
Date
5.
Send Tax Clearance Application to:
Arizona Department of Revenue
TCS 7th Floor
PO Box 29070
Phoenix AZ 85038-9070
Telephone (602) 542-4472
Power of Attorney: If this application is submitted by anyone other than a Corporate Officer, General Partner, or Individual (Sole
Proprietor), Arizona Form 285 (General Disclosure/Representation Authorization Form) is required. See
Unsigned applications will not be processed and faxed applications will not be processed.
** Not applicable to Estate, Trust, or Individual application types.
ADOR 25-0002 (5/01)

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