Blank Arizona 652 PDF Template Modify Form Now

Blank Arizona 652 PDF Template

The Arizona 652 form is a document used to report abandoned property to the Arizona Department of Revenue. This form helps holders, such as financial institutions or businesses, to disclose unclaimed assets that may belong to individuals. Properly completing this form ensures that rightful owners can reclaim their property and helps maintain transparency in the handling of abandoned assets.

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Overview

The Arizona 652 form, officially known as the Report of Abandoned Property, is a crucial document for individuals and businesses in the state of Arizona. This form is used to report unclaimed property to the Arizona Department of Revenue's Unclaimed Property Section. It captures essential details such as the holder's name, federal employer identification number, and the total amount remitted. Each entry on the form requires specific information about the abandoned property, including account numbers, cash amounts, interest rates, and the last activity date. Additionally, it collects personal information about the owners, such as their names, mailing addresses, tax identification numbers, and dates of birth. If there are multiple owners for a property, the form provides space to include details for each additional owner. This ensures that all relevant parties are accounted for in the reporting process. Completing the Arizona 652 form accurately is vital for compliance with state laws and for the rightful owners to reclaim their property.

Form Example

ARIZONA FORM Arizona Department of Revenue • Unclaimed Property Section

652 REPORT OF ABANDONED PROPERTY - SCHEDULE A

HOLDER NAME

Federal Employer Indenti

Grand Total Remitted

$

Item no.

Account #

 

 

 

 

 

Check #

 

 

 

 

 

NAUPA property type

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash amount remitted

 

 

 

Interest rate

 

 

 

 

 

 

Last activity date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner’s last name

 

 

 

Owner’s first name / middle initial

Owner’s mailing address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State, ZIP code

 

 

 

Country

 

Owner’s Tax ID (SSN or EIN)

Owner’s date of birth

NAUPA relationship code

 

 

 

 

 

 

 

 

 

 

 

Fee/Drilling cost

No.of shares remitted

 

Security/Mutual Fund name

 

 

CUSIP no.

Date of Death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE THE FIELDS BELOW IF THERE IS MORE THAN ONE OWNER FOR THIS PROPERTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional owner’s last name

 

 

Additional owner’s first name / middle initial

Additional owner’s Tax ID (SSN or EIN)

Relationship code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional owner’s date of birth

 

Additional owner’s date of death

Other information available

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional owner’s last name

 

 

Additional owner’s first name

/ middle initial

Additional owner’s Tax ID (SSN or EIN)

Relationship code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional owner’s date of birth

 

Additional owner’s date of death

Other information available

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item no.

Account #

 

 

 

 

 

Check #

 

 

 

 

 

NAUPA property type

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash amount remitted

 

 

 

Interest rate

 

 

 

 

 

 

Last activity date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner’s last name

 

 

 

Owner’s first name / middle initial

Owner’s mailing address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State, ZIP code

 

 

 

Country

 

Owner’s Tax ID (SSN or EIN)

Owner’s date of birth

NAUPA relationship code

 

 

 

 

 

 

 

 

 

 

 

Fee/Drilling cost

No.of shares remitted

 

Security/Mutual Fund name

 

 

CUSIP no.

Date of Death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE THE FIELDS BELOW IF THERE IS MORE THAN ONE OWNER FOR THIS PROPERTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional owner’s last name

 

 

Additional owner’s first name / middle initial

Additional owner’s Tax ID (SSN or EIN)

Relationship code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional owner’s date of birth

 

Additional owner’s date of death

Other information available

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional owner’s last name

 

 

Additional owner’s first name

/ middle initial

Additional owner’s Tax ID (SSN or EIN)

Relationship code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional owner’s date of birth

 

Additional owner’s date of death

Other information available

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAGE OF

ADOR 11017 (8/11)

Document Characteristics

Fact Name Description
Form Purpose The Arizona 652 form is used to report abandoned property to the Arizona Department of Revenue.
Governing Law This form is governed by Arizona Revised Statutes, Title 44, Chapter 3.
Holder Information Holders must provide their name, Federal Employer Identification Number, and the total amount remitted.
Owner Details Information about the owner includes name, mailing address, Tax ID, and date of birth.
Multiple Owners If there are multiple owners, additional fields for their information are included in the form.
Property Types The form includes various NAUPA property types, such as cash, securities, and mutual funds.
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