Arizona Form 285Up PDF Details

The Arizona Form 285Up serves as a critical bridge connecting claimants to their unclaimed property through the Arizona Department of Revenue. Designed to navigate the complexities of unclaimed property claims, this form enables individuals to officially designate another party, such as a lawyer or certified public accountant, to act on their behalf. This authorization can range from obtaining confidential information to exerting power of attorney for unclaimed property administrative matters. It specifically outlines the necessary claimant and appointee information, including identification details and contact information, ensuring a transparent process. Furthermore, the form encompasses a detailed approach towards the release of confidential information and the extent of authorization granted to the appointee, including limited to full power of attorney options. Importantly, it also addresses the revocation of previous authorizations, reflecting its comprehensive nature in safeguarding both claimant's rights and the integrity of the unclaimed property process. For corporations with controlled subsidiaries, it stipulates the requirements for disclosing confidential information, reinforcing its role in providing an organized and authoritative mechanism for claimants to manage or reclaim their property effectively.

QuestionAnswer
Form NameArizona Form 285Up
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesunclaimed property arizona, arizona property disclosure form, az form unclaimed property, az form285up

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ARIZONA FORM

Unclaimed Property Disclosure/Representation Authorization Form

 

285UP

 

ARIZONA DEPARTMENT OF REVENUE

 

 

 

 

 

 

 

 

 

1. CLAIMANT INFORMATION - Please print or type.

 

Enter only those that apply:

 

Claimant name

 

 

Social Security Number(s)

 

 

 

 

 

 

Present address

 

 

Federal Employer Identification Number

 

 

 

 

 

 

City, town or post office

State

Zip Code

Daytime telephone number

 

 

 

 

(

)

2. APPOINTEE/DESIGNEE OF CLAIMANT INFORMATION

 

Provide Number, as applicable:

 

Name

 

 

State and State Bar Number

 

 

 

 

 

 

Present address

 

 

State and Certified Public Accountant Number

 

 

 

 

 

 

City, town or post office

State

Zip Code

Social Security or Other ID Number

Daytime telephone number

()

3.RELEASE OF CONFIDENTIAL INFORMATION. The appointee named above is authorized to receive confidential information relating to the unclaimed property of the claimant named above. By signing this form, I authorize the Department to release confidential information of the claimant to the appointee.

To grant a limited power of attorney, complete section 4. To grant a full power of attorney, complete section 5.

4.LIMITED POWER OF ATTORNEY. Items 4a through 4e allow the claimant to grant additional authorization to the appointee named above with regard to Unclaimed Property administrative matters before the Department of Revenue. Please check the appropriate boxes. The additional authorization must be in accordance with Arizona Supreme Court Rule 31. See instructions.

4a Appointee shall have the power to claim and collect unclaimed property on behalf of the Claimant.

4b Appointee shall have the power to sign a statute of limitations waiver on Claimant’s behalf.

4c Appointee shall have the power to execute a protest of a deficiency assessment or a denied claim or to execute an agreement on Claimant’s behalf. 4d Appointee shall have the power to request a formal hearing on Claimant’s behalf.

4e Appointee shall have the authority to delegate to others any or all authority granted to appointee by this document.

4f Other (please specify):

5. POWER OF ATTORNEY. By checking the box on line 5, the claimant named above grants the appointee named above a Power of Attorney to perform any and all acts that the claimant can perform with regard to Unclaimed Property administrative matters before the Department of Revenue.

6.REVOCATION OF EARLIER AUTHORIZATION(S). This Authorization revokes any earlier Unclaimed Property Authorizations on file with the Arizona Department of Revenue for the same year covered by this authorization.

ADOR 17-5535 (5/06)

AZ FORM 285UP (2006) PAGE 2

7.CORPORATIONS HAVING CONTROLLED SUBSIDIARIES. A.R.S. §42-2003(A)(1) provides that confidential information relating to a corporate taxpayer may be disclosed to a designee of the taxpayer who is authorized in writing by the taxpayer. A principal corporate officer of a parent corporation may execute a written authorization for a controlled subsidiary. A principal corporate officer of a parent corporation that desires to designate a person to receive confidential information regarding the corporation’s controlled subsidiaries must either attach a list containing the names of each controlled subsidiary that the parent company wants included in the disclosure authorization (a federal Form 851 may be used for this purpose) or Claimant may complete the following to include all controlled subsidiaries in the disclosure authorization.

Include the following controlled subsidiaries. A controlled subsidiary, for purposes of A.R.S. §42-2003, is defined as more than 50% ownership or control.

NAME

FEDERAL I.D. NO.

7a

7b

7c

7d

7e

7f

8.SIGNATURE OF CLAIMANT. I hereby certify that I have the authority, within the meaning of A.R.S. §42-2003(A), to execute this authorization form on behalf of the above claimant. I understand that to knowingly prepare or present a document which is fraudulent or false is a Class 5 felony pursuant to A.R.S. §42-1127(B)(2).

SIGNATURE

DATE

PRINT NAME

TITLE

9.DECLARATION OF APPOINTEE. Complete if Appointee has been given authority under Section 4 or Section 5 or is otherwise authorized to pratice law as defined in Rule 31 of the Arizona Rules of the Supreme Court.

Under penalties of perjury, I, the above named appointee, declare that I am one of the following:

a A full-time officer, partner, member or manager of a limited liability company, or employee if the individual qualifies under Rule 31(c)13 of the Arizona Rules of the Supreme Court.

b Attorney - an active member of the State Bar of Arizona.

c Certified Public Accountant - duly qualified to practice as a Certified Public Accountant in Arizona.

d Federally Authorized Tax Practitioner within the meaning of A.R.S. § 42-2069(D)(1). If appointee is engaged in practice with a federally authorized tax practitioner, provide the practitioner’s name and CAF number below:

_______________________________________________________

___________________________

PRACTITIONER’S NAME

CAF NUMBER

eOther - This may be any individual, providing the total amount in dispute, including tax, penalties, and interest is less than $5,000.00.

DESIGNATION

JURISDICTION

 

Enter a letter (a, b, c d or e).

(State)

SIGNATURE

 

 

 

If this Declaration of Appointee is not signed and dated, the representation authorization will be returned.

Mail completed form to:

Arizona Department of Revenue Unclaimed Property Unit

1600 W. Monroe Street Phoenix, AZ 85007

DATE

ADOR 17-5535 (5/06)

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1. Fill out the arizona property disclosure form with a selection of necessary blank fields. Note all of the information you need and be sure there is nothing left out!

Filling out section 1 in 285up

2. Once the previous part is done, you have to include the required specifics in a Appointee shall have the power, POWER OF ATTORNEY By checking the, to perform any and all acts that, and REVOCATION OF EARLIER so you can move forward to the third part.

 REVOCATION OF EARLIER,  to perform any and all acts that, and a Appointee shall have the power inside 285up

3. Through this part, have a look at NAME, FEDERAL ID NO, SIGNATURE OF CLAIMANT I hereby, above claimant I understand that, SIGNATURE, PRINT NAME, TITLE, DATE, and DECLARATION OF APPOINTEE Complete. All these will need to be filled out with highest accuracy.

Completing section 3 of 285up

4. You're ready to start working on this fourth section! Here you have these practitioner provide the, PRACTITIONERS NAME, CAF NUMBER, e Other This may be any, DESIGNATION, JURISDICTION, Enter a letter a b c d or e, State, SIGNATURE, DATE, If this Declaration of Appointee, Mail completed form to, Arizona Department of Revenue, and ADOR empty form fields to fill in.

Filling out segment 4 of 285up

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