Form Ador 74-4008 - Bond Release Request For Contractors
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1
2ARIZONA DEPARTMENT OF REVENUE
ARIZONA DEPARTMENT OF REVENUE
Bond Release Request for Contractors
Bond Release Request for Contractors
Please complete this form to request release of taxpayer bonds. Please
Transaction Privilege
note that bonds submitted under ARS § 42-5006 are required by law to
Tax license number
be held by the Department of Revenue for a minimum of two years. If
Withholding identifi cation
you are requesting release prior to two years, circumstances must be
number
exceptional. Release is not allowed in any case where there is a poten-
Federal taxpayer identifi cation
tial tax liability. Bonds submitted under ARS § 42-5007 can be released
number (TIN)
if the taxpayer shows that the taxes have been paid.
Business name
Business telephone
Mailing address
City
State
Zip
Is your business headquartered out-of-state?
Yes
No
Parent company name
Business telephone
Mailing address
City
State
Zip
Reason for request
Is your business being sold?
Yes
No
Are you also requesting cancellation of your transaction privilege tax and/or withholding licenses?
Yes
No
Has your Registrar of Contractor’s license been cancelled?
Yes
No
Are there any additional contracts which have not been reported on sales tax returns?
Yes
No
If yes, please explain.
Do you have any other license with the Department of Revenue?
Yes
No
If yes, indicate type of license and number.
If you are requesting release of a bond submitted under ARS § 42-5007 for contracts over $50,000, please provide the following:
Bond amount
Original claimed contract amount
Actual contract amount
Month reported on TPT-1
I certify that the above statements are true.
SIGNATURE
TITLE
DATE
NOTARY
ADOR 74-4008 (9/02)
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