Arizona Form 650A PDF Details

If you're a resident of Arizona, you may be required to complete and submit Form 650A when filing your state income tax return. This form is used to calculate the amount of tax you owe on your gambling winnings for the year. Whether you won big or just had a lucky night at the casino, make sure to report all of your gambling income correctly on Form 650A. Failing to do so can result in costly penalties and interest charges. Let this guide walk you through everything you need to know about completing and submitting Form 650A.

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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