Collection of personal property affidavit

Sole proprietorship affidavit

Form is used to file a claim for Unclaimed Property.
This form must be completed and included with the documentation listed in Section 3 of the form, when filed.

Your claim will be considered invalid if the required documentation is not provided.

Note: Due to our established business procedure for processing mail, we are unable to honor special requests such as returning original documents.

After a report is submitted, a holder may choose to repay the owner directly or may determine that items within the report were filed in error. In these cases, the holder may seek reimbursement by submitting the Holder Request for Reimbursement form (Arizona Form 670) along with the required documentation substantiating the repayment or error. Please use the current version, 670 revised 09/09. All other forms are obsolete and will not be accepted.

Agreement to indemnify the State and hold it harmless against any and all claims, judgments, decrees, cost, expenses (including reasonable attorney fees) or any other loss which the State might sustain by reason of delivering or relinquishing said property to me and by reason of the State’s refusal hereafter to deliver said property or any part thereof to any other persons or entities.

The Negative Report of Unclaimed Property applies to entities that have no unclaimed property to report for the required period.

DO NOT file Negative reports on CD, DVD or USB flash drive.

If your report contains more than 10 items you MUST submit an electronic file in NAUPA Standard Format. Form 652 (Schedule A) MUST be completed if you are reporting 10 items or less and are not submitting an electronic file.

This Schedule A must accompany a Form 650A or 650B and should be utilized ONLY if your report contains 10 items or less.

Every person, corporation or other business association, banking or financial organization, life insurance corporation, utility, court or public authority must complete the following checklist before filing their Arizona Annual Report of Property Presumed Abandoned. This checklist includes by way of illustration, but not limitation, those items which are covered by Section 44-301 et seq of the Arizona Revised Uniform Unclaimed Property Act. All of the following types of property, with the exception of travelers checks must be reported if they have remained unclaimed for one or more years.

If your report contains more than 10 items you MUST submit an electronic file in NAUPA Standard Format. Form 652 (Schedule A) MUST be completed if you are reporting 10 items or less and are not submitting an electronic file.

If you are remitting abandoned property, please use Arizona Form 650A.

If you are remitting safe deposit box contents, please use Arizona Form 650C.