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- ARIZONA FORM Arizona Department of Revenue
- 600A Claim for Unclaimed Property - Original Owner
- For assistance in the Phoenix area: (602) 364-0380 or
- Outside the Phoenix area toll free: (877) 492-9957
- Mail To: Arizona Department of Revenue Unclaimed Property Unit P.O.Box 29026Phoenix, AZ 85038-9026
- 1. Original Owner's Name: JONATHAN MEANS 2. Property ID: 3986049
- 3. Original Owner's Social Security or Tax Identification Number
- ____________________ ____________________
- 4. Original Owner's Address as reported by holder:
- 5450 EAST PIPING ROCK ROAD
- SCOTTSDALE, AZ 85254
- 5. Mailing address (Where you would like correspondence, including payment sent)
- 47 SAINT ANDREWS DR
- BEAVER FALLS, NC 15010
- In order to initiate a claim for this property the following information must be included:
- You must provide a clear copy of your official photo identification or have the claim form notarized below
- You must provide proof of your social security number
- You must provide proof that you lived or received mail at the address listed above in item #4
- Examples of proof include:
- Auto Registration or Driver’s License
- Birth, Death, Marriage or Stock Certificate
- Bank or Utility Statement
- Medicare card or insurance Policy
- Credit Report
- School Transcripts
- Court Documents
- State Income Tax returns
- Postmarked envelope addressed to you
- NOTE: Joint owners must each submit a claim form.
- Declarations: I swear under penalty of perjury that statements I made on this claim form and any other statements that I made or will make during the claims process are true and correct to the best of my knowledge. Photocopies I have provided or will provide are the same as the original document. I understand that additional evidence may be needed to process my claim and that the claims processing staff may contact me in that case. I agree that if for any reason it is found that I am not entitled to this payment or I receive a duplicate payment, I will return the funds to the Arizona Department of Revenue within 15 days.
- 7. Claimant’s Name
- MEANS
- Last Name
- JONATHAN, DAVID
- First Name, Initial
- 162664058
- Social Security Number ( 602 ) 492 - 6009
- Telephone Number
- Signature: ____________________________________________ Date: ____________________
- Subscribed and Affirmed before me by: _____________________________________
- Affix Seal Here
- ________________________________________________________________
- Notary Signature Date
- Notary in and for the State of _________________ My Commission Expires ________________
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