REVENUE USE ONLY. 
      Arizona Form                                                                   Do not mark in this area.
                              Request for Copies of Fraudulent Returns
       470
                                                                                     No.   _______________________

       Read instructions on reverse side before completing this form.  Please print or type.

 Name(s)1                                              2 Social Security Number(s)

  A.                                                  A.

  B.                                                  B.

 3   Tax return for period(s):

 4   Current address:                                  5 Mail copies to: 

 Signature:6                                          7 Instructions:
                                                         1) FEES:
                                                                Full payment must be included with your request. 
                                                                Check or money order only.  Your canceled check 
  PRINT OR TYPE NAME OF REQUESTOR                               is your receipt.  Check one box below:
                                                                Uncertified Copy,$2.00pertaxperiod
   
  SIGNATURE OF REQUESTOR                                 2) Mail completed and signed form to: 
                                                                 Arizona Department of Revenue 
                                                                Copy Desk 
 TITLE (if applicable)
                                                                 PO Box 29216 
                                                                Phoenix, AZ85038-9216
                           
  DATE                 DAYTIME PHONE (with area code)

                                                     Print Form

                                  DEPARTMENT OF REVENUE USE ONLY
                                                                 DOCUMENT NUMBER(S)
       Serial Number:                                  
    Amount Received:                                   
       Postmark Date:                                  
       Date Received:                                  
       Date Mailed:                                    
    Billed/Refunded:                                   
    Comments:                                           
   ADOR 11299 (16)

                                                                                                                           Arizona Form 
 Request for Copies of Fraudulent Returns                                                                                  470 
                                                                                  
 Phone Numbers 
                                                                                  4 and 5 -Current or Mailing Address       
 For more information or help, call one of the numbers listed                     Fill in your current address.  If different from your current 
 below.                                                                           address, enter the address to which the department should 
                                                                                  mail the copies.  (If the same as current address,  leave 
 Phoenix                                                          (602) 255-3381 
                                                                                  mailing address blank.) 
 From area codes 520 and 928, toll-free         (800) 352-4090 
                                                                                  6 -Signature       
 Instructions                                                                     Sign and date your request.  We will not process your request 
                                                                                  if you do not sign the form.  
 A victim of identity theft may use this form to request a                        7 - Fees 
 redacted copy (one with some information blacked out) of a 
 fraudulent return that was filed using the identity theft                        There is a fee of $2.00 per tax period for copies of fraudulent 
 victim’s name and social security number.  Although some                         tax returns.  Full payment must be included with your 
 information will be redacted, the remaining information will                     request before the request can be completed.  You may pay 
 allow you to determine what information the identity thief                       by check or money order made payable to the Arizona 
 may have about you.                                                              Department of Revenue.  Your cancelled check is your 
                                                                                  receipt. 
 1 - Name(s)                                                                      
 Fill in the identity theft victim’s full name.  If married, put                  How to File 
 the spouse’s name on line B.                                                     
                                                                                  Mail your completed form to: 
 2 - Social Security Number(s)                                                            Arizona Department of Revenue 
 Fill in the identity theft victim’s Social Security Number                               Copy Desk 
 (SSN).  If married, put the spouse’s SSN on line B.                                      P O Box 29216 
 3 - Tax Period(s)                                                                        Phoenix, AZ 85038-9216 
                                                                                           
 Fill in the year(s) needed.  You can request returns for the                              
 current tax year and the two previous tax years.                                          
 
 Frequently Asked Questions 
  
 How long will it take to get a copy of the fraudulent return? 
 The time required to fulfill a request depends on a number of factors.  One factor is whether there are any unresolved issues concerning 
 the return.  The department will need to resolve any identity theft issues before providing the return.  The department may also need to 
 hold off providing a return if disclosure of the return may compromise a pending investigation.   
  
 The department will acknowledge your request within 30 days and within 90 days you should receive the returns or follow-up 
 correspondence. 
  
 What information will be redacted? 
   Return Information                                                            Redaction 
   Names of the primary taxpayer, secondary taxpayer and                         Each name except the first four letters of the last name.  (If the 
   dependents                                                                    last name has four or fewer letters, the last name will remain 
                                                                                 visible) 
   Address of the primary and secondary taxpayer                                 Entire address except the street name 
   Name and address of all other persons or entities on                          Entire name and address 
   return 
   Taxpayer identification number such as SSN                                    Entire number except for last four digits 
   Personally identifiable numbers such as designee’s                            Entire number  
   Personal Identification Number or preparer’s Tax 
   Identification Number 
   Telephone numbers                                                             Entire number except for last four digits 
   Bank routing and account numbers                                              Entire number except for last four digits 
   Signature                                                                     Entire signature 
  
                                                  Print Instructions