Arizona Form 650A PDF Details

In the intricate landscape of financial obligations, the Arizona Form 650A emerges as a critical conduit for ensuring the return of abandoned property to its rightful owners. Administered by the Arizona Department of Revenue's Unclaimed Property Section, this form serves as a declaration by entities (holders) that possess or have knowledge of property deemed abandoned. These holders, ranging from corporations to small businesses, are mandated to submit an annual report, detailing such properties in accordance with state laws. The form meticulously guides holders through the process, requesting essential information such as the entity's name, federal ID number, and specifics about the abandoned property, including the total amounts under and over $50, whether the owners are known or unknown, and a comprehensive list of individual owners and properties. It emphasizes the importance of direct communication lines by requiring contact details for both the entity filing the report and a point of contact for the owners of the reported property. Moreover, the form highlights the holder's responsibility to attempt to notify the rightful owners before escheating the property to the state, adhering to the protocols outlined in Arizona's Unclaimed Property Reporting Manual and under the scrutiny of state law A.R.S. § 44-307. The declaration concludes with a certification by the reporting entity, validating the accuracy and completeness of the information provided under penalty of perjury. Form 650A is not just a procedural requirement; it embodies the state's commitment to reuniting individuals with their unclaimed assets, fostering a sense of trust and accountability within the financial ecosystem.

QuestionAnswer
Form NameArizona Form 650A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesaggregate, remitted, remitting, 650B

Form Preview Example

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)

 

Name

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)

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