Arizona Form 450 - Request For Copies Of Tax Documents
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1REVENUE USE ONLY.
Do not mark in this area.
Arizona Form
Request for Copies of Tax Documents
450
No. _______________________
Read instructions on reverse side before completing this form. Please print or type.
1
2
Name(s) as shown on document:
SSN and/or ID number as shown on document:
A.
A.
B.
B.
3
4
Tax return for period(s):
Tax type. Check only one:
Individual Income Tax
Corporate Income Tax
Transaction Privilege & Use Tax
Withholding
When filed:
Other. Please specify:
Mail copies to:
5
6
Current address:
7
Signature:
8
Instructions:
1) FEES:
Full payment must be included with your request.
Check or money order only. Your canceled check
is your receipt. Check one box below:
PRINT OR TYPE NAME OF REQUESTOR
Uncertified Copy, $5.00 per tax period
Certified Copy, $7.00 per tax period
SIGNATURE OF REQUESTOR
2) Mail completed and signed form to:
Arizona Department of Revenue
Copy Desk
TITLE (if applicable)
PO Box 29216
Phoenix, AZ 85038-9216
DATE
DAYTIME PHONE (with area code)
3) Please allow ten (10) days for processing after
receipt by the ADOR Copy Desk.
Print Form
DEPARTMENT OF REVENUE USE ONLY
DOCUMENT NUMBER(S)
Serial Number:
Amount Received:
Postmark Date:
Date Received:
Date Mailed:
Billed/Refunded:
Comments:
ADOR 10582 (16)
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