Fillable Form Ador 10523 - Tax Clearance Application printable pdf download

Tax Clearance Application

GENERAL INSTRUCTIONS

PURPOSE OF FORM

taxpayer, the application cannot be processed and is

considered invalid unless the application is accompanied

To apply for Certificate of Compliance for Letter of Good

by an Arizona Form 285, General Disclosure/

Standing, Dissolution and/or Withdrawal

Representation Authorization Form (power of attorney).

Arizona Form 285 is available on the Arizona Department

SPECIFIC INSTRUCTIONS

of Revenue web site,

Section 1 - Applicant Information

Section 5 - Important Information

Enter the applicant’s name, as licensed, name of the

The department does not accept faxed applications.

entity for which the certificate will be issued.

The

Mail the completed and signed application to the:

application will be denied if the name does not match the

Arizona Department of Revenue

Taxpayer Identification Number or the Federal Employer

Collections Administrative Support

Identification Number entered.

ATTN: TCA Process

Enter the applicant’s daytime telephone number, current

PO Box 29070

street address, city, state and zip code.

Phoenix, AZ 85038

Section 2 - Tax Clearance Purpose

or deliver the application to:

1600 West Monroe

Check the box for the type of certificate requested:

First Floor Collections

A Certificate of Compliance for Dissolution or Withdrawal

Phoenix, AZ 85007

is specifically for dissolution of a corporation or is for an

Telephone: (602) 716-6234

entity wishing to withdraw from Arizona.

Denied Applications:

If your application is denied,

A Letter of Good Standing request is for the sale of a

a written notice of denial will be sent to you. If any

business, personal reason, residency, gaming, healthy

application is denied, you must submit a new application.

forest or motion picture credit, renewable energy tax

Processing: Arizona does not have an expedited process

incentive, or other reason.

for Tax Clearance Applications.

An application for

Section 3 - Application Type

a Letter of Good Standing takes 15 business days to

process. An application for dissolution or withdrawal

Check only one box for the type of entity making the

takes 30 business days to process.

request.

Confidentiality:

The department does not release

Enter the Federal Employer Identification Number or the

information to anyone other than the taxpayer or a

Taxpayer Identification Number.

representative as evidenced by a valid power of attorney

Enter the Arizona Transaction Privilege License Number.

on file with the department.

If the business does not have one, leave blank.

Compliance: You must be in full compliance with any

Enter the Arizona Withholding Tax License Number. If

and all Arizona tax filing and tax payment requirements

the business does not have one, leave blank.

in order to receive a certificate. All delinquent returns

filed and balances must be paid in full prior to filing tax

Estates or Trusts: Enter the Taxpayer Identification

clearance application.

Number or Federal Employer Identification Number.

Dissolution and Withdrawal: You must have canceled

Individuals: Enter your Social Security Number. (Last

all required licenses with the department in order to

six years or prior will be checked)

receive a certificate. You must have filed a final corporate

Section 4 - Signature

income tax return in order to receive a certificate.

This area is for the signature of the individual taxpayer,

Other Information:

the corporate officer, partner or member of the business

If your business files a consolidated return, a notarized

requesting the certificate.

Letter of Assumption must be submitted with your

application.

Print the name of the taxpayer. Print the title of the

taxpayer, owner, partner, president, vice president, etc.

If your business is tax exempt, you must submit with your

Sign and date the application. The signature must be

application a Letter of Determination from the Internal

legible.

Revenue Service.

Unsigned applications will not be processed.

Go to Form

If the application is signed by anyone other than the

INSTRUCTIONS

ADOR 10523 (9/13)

Form Ador 10523 - Tax Clearance Application

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