The Arizona 650A form is a report used to declare abandoned property to the Arizona Department of Revenue. This form is essential for businesses and entities that need to report unclaimed assets, ensuring compliance with state regulations. Understanding how to fill out and submit this form can help protect both the holder and the rightful owners of the property.
The Arizona 650A form plays a crucial role in the management of unclaimed property within the state. This form is used by entities, often referred to as holders, to report abandoned property to the Arizona Department of Revenue. It requires detailed information about the entity, including its name, federal ID number, and contact details for both the entity and the customers whose property is being reported. The form differentiates between types of abandoned property, allowing for the reporting of securities, safe deposit box contents, and other assets. Holders must summarize the total amounts of properties under and over $50, as well as those with known and unknown owners. Additionally, the form mandates that holders provide a true and correct list of individual owners and properties, ensuring transparency and compliance with state laws. Significantly, it also includes a certification section where the holder affirms the accuracy of the information provided, thereby reinforcing the importance of accountability in the reporting process. This structured approach not only facilitates the return of unclaimed property to rightful owners but also enhances the efficiency of the state's unclaimed property program.
ARIZONA FORM Arizona Department of Revenue • Unclaimed Property Section
650A
REPORT OF ABANDONED PROPERTY
DATE STAMP
If you are remitting securities, please use Arizona Form 650B
If you are remitting safe deposit box contents, please use Arizona Form 650C
1
Entity Name (Holder)
Federal ID Number
State/Date of Incorporation
Report Type
Annual Report
Life Insurance
Prior Name - If Entity Name has changed
Previous Holder - If you are a successor to a previous holder
Contact Person - For questions from staff members of the Arizona Department of Revenue
Name
Title
Direct Telephone Number
E-mail Address
Mailing Address
City
State
ZIP code
2
Customer Contact (for use by owners of reported property)
Same
Telephone Number
E-Mail Address
3
Summary of Abandoned Property Report
Total amount of properties under $50
In order to facilitate customer service, we request that, when possible,
$
you do not aggregate these funds in your report.
Total amount of properties over $50 with known owners
Total amount of properties with unknown owners
Total amount of report
44a. I have attached a true and correct list (Schedule A) of individual owners and properties, in accordance with A.R.S. § 44-307(B). Reporting software is available for free download on our website www.azunclaimed.gov.4b. I have reviewed and understand the State of Arizona payment protocols (see Arizona Unclaimed Property Reporting Manual)
The relationship codes reported for each property will allow accurate payment to the reported owners.
4c. Written notice has been sent to the owners of all properties being reported/remitted in accordance with A.R.S. § 44-307(E).
5I hereby certify that I have the authority to execute this report of Unclaimed Property on behalf of the above named holder. I declare under penalty of perjury that the foregoing information, the information set forth in the schedules, and all documentation I have or will provide is true and complete.
Print Name
Signature
Date
Mailing address: Arizona Unclaimed Property Section 1600 West Monroe Street, Phoenix, AZ 85007
FOR DEPARTMENT USE ONLY
Deposit No.
Receipt No.
Holder No.
Check No.
Check Amount
Report No.
ADOR 10755 (8/11)
Arizona Immunization Registry - This form also indicates the process for rescinding the exemption should parents decide to vaccinate their child later.
Wic Arizona - Signatures from healthcare providers and local nutritionists or state officials are required for approval, emphasizing the form’s medical and nutritional validity.
Are Services Taxable in Arizona - Vendors accepting the certificate in good faith are relieved from proving the exemption, shifting the responsibility to the purchaser.