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:
                                                            UncertifiedCopy,$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)

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