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Tax Clearance Application GENERAL INSTRUCTIONS
PURPOSE OF FORM Section 5 - Important Information
To apply for Certificate of Compliance for either, Letter of Power of Attorney
Good Standing,Dissolution or Withdrawal If this application is submitted by anyone other than a
corporate officer, general partner, or individual (sole
SPECIFIC INSTRUCTIONS proprietor), Arizona Form 285B, Disclosure Authorization
Form, is required. Visit our website at www.azdor.gov and
Section 1 - Applicant Information click on the Forms link to obtain Form 285B.
Enter the applicant’s name, as licensed, name of the
entity for which the certificate will be issued. The Confidentiality: The department does not release
information to anyone other than the taxpayer or a
application will be denied if the name does not match the
representative as evidenced by a valid power of attorney
Taxpayer Identification Number or the Federal Employer
or disclosure Authorization form on file with the department
Identification Number entered. . (A file number per the
or with the application.
Arizona Corporation Commissions has no relation to a
Federal Employer Taxpayer Identification Number). Denied/Approval Applications: If your application
is denied, a denial letter will be sent by mail. Once the
Enter the applicant’s daytime telephone number with ext.,
deficiencies are cleared, you must resubmit a new
current mailing address, city, state and zip code.
application to restart the process. If your application is
Section 2 - Tax Clearance Purpose approved a certificate will be sent by mail.
Check the box for the type of certificate requested: Processing: Arizona does not have an expedited
process for Tax Clearance Applications. An application
A Certificate of Compliance for Dissolution or
for a Letter of Good Standing (A.R.S.42-1110) takes
Withdrawal is specifically for dissolution of a corporation or 15
is for an entity wishing to withdraw from Arizona. business days to process. An application for Dissolution
or Withdrawal (A.R.S.43-1151) takes 30 business days
A Letter of Good Standing request is for the healthy forest to process. There is no fee for this service. For faster
certification, air carrier apportionment, personal reason, processing, please file and pay Online.
renewable energy tax incentive, residency, sale of a
Compliance: You must be in full compliance with any
business, or other reason.
and all Arizona tax filing and tax payment requirements
Section 3 - Application Type in order to receive a certificate. All delinquent returns
filed and balances must be paid in full prior to filing tax
Check only one box for the type of entity making the clearance application. If you are on a payment plan this
request.
will not suffice, your account needs to be paid in full.
Enter the Federal Employer Identification Number or the
Dissolution and Withdrawal: You must have cancelled
Taxpayer Identification Number.
all required licenses with the department in order to receive
Enter the Arizona Transaction Privilege License Number. a certificate. You must have filed a final corporate income
If the business does not have one, leave blank. tax return in order to receive a certificate.
Enter the Arizona Withholding Tax License Number. If the If your business files a consolidated return, a notarized
business does not have one, leave blank. Letter of Assumption must be submitted from the ultimate
parent company with your application.
Estates or Trusts: Enter the Taxpayer Identification
Number or Federal Employer Identification Number. Other Information:
If your business files a consolidated return, a notarized
Individuals: Enter your Social Security Number. (Last
Letter of Assumption must be submitted from the ultimate
six years or prior will be checked)
parent company with your application.
Section 4 - Signature If your business is tax exempt or non-profit, you must
This area is for the signature of the individual taxpayer, submit with your application a Letter of Determination from
the corporate officer, partner or member of the business the Internal Revenue Service.
requesting the certificate. Application Submission:
Print the name of the taxpayer. Print the title of the taxpayer, For submission details please see the following Tax
owner, partner, president, vice president, etc. Sign and Clearance Application form on the next page.
date the application. The name must be legible.
Unsigned applications will not be processed.
ADOR 10523 (11/22) INSTRUCTIONS
