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Notice of Assumption                                                                              Arizona Form 
of Duties in a Fiduciary Capacity                                                                    210 
 
For information or help, call one of the numbers listed:            Foreign Addresses 
Phoenix                                (602) 255-3381               If the decedent had a foreign address, enter the information in 
From area codes 520 and 928, toll-free (800) 352-4090               the following  order:   city, province or state, and country.  
Department’s Fiduciary Unit            (602) 716-7809               Follow the country’s practice for entering the postal code.  Do 
                                                                    not abbreviate the country name.
Tax forms, instructions, and other tax information                                                   
If you need tax forms, instructions, and other tax information,     Section 2: Fiduciary Information 
go to the department’s website at www.azdor.gov.                    NOTE:  If there is more than one Fiduciary for the estate, 
                                                                    complete a separate Form 210 for each fiduciary.   
Income Tax Procedures and Rulings 
These instructions  may refer to the department’s income tax        Enter the fiduciary’s name, address, and telephone number.  
procedures and rulings for more information.  To view or print      If the  fiduciary is an entity, include  the  name and phone 
these, go to our  website  select Reports, Statistics and Legal     number  of an individual  for  contact purposes  regarding non-
Research  from the  main  menu, then click on  Legal Research       confidential tax matters.  
and select a Document Type and Category from the drop down          If a fiduciary wishes to authorize an individual to represent or 
menus.                                                              perform  certain  acts  on  behalf  of  the  entity,  a  Power  of 
Publications                                                        Attorney must be filed and signed by the fiduciary acting in the 
To view or print the department’s publications,  go to our          position of the taxpayer.  Use  Arizona Form 285 for this 
website select Reports, Statistics and Legal Research from the      purpose.  Form 285 may be filed with Form 210.  
main  menu then click on Publications  in the left-hand  side       If the fiduciary has a foreign address, enter the information in 
column.                                                             the following order:   city, province or state, and country.  
                                                                    Follow the country’s practice for entering the postal code.   Do 
Purpose of Form                                                     not abbreviate the country name. 
Use Form 210 to notify the Arizona Department of Revenue of         Section 3: Probate Information 
a fiduciary relationship for a decedent's estate. A fiduciary for a Complete this  section only  if the decedent's estate is being 
decedent's estate may be any of the following:                      probated.  
• an executor;                                                      •  Enter the name of the county in which probate proceedings 
• an administrator;                                                    are being conducted.  
• a personal representative; or                                     •  Enter  the  probate  number,  the  date  of  the  fiduciary's 
                                                                       appointment, and the name, address, and telephone number 
• a person in possession of property of a decedent. 
                                                                       of the attorney for the estate. 
Who Should File                                                     If an estate is being probated, the fiduciary may have to obtain 
The fiduciary should file Form 210 to notify the department of      a  Certificate  of Payment of  Taxes  from the department that 
either of the following:                                            shows no income tax is due. The probate court may require this 
• the creation of a  fiduciary relationship  for a decedent's       certificate before approving the fiduciary's final account. 
  estate, or                                                        Arizona  law requires a certificate only  when     all  of the 
• the termination of a fiduciary relationship for a decedent's      following apply. 
  estate.                                                           1. The estate is subject to probate. 
                                                                    2. On the date of death, the value of the assets of the estate 
Instructions                                                           exceeded $20,000. 
                                                                    3. The estate has a beneficiary that is not an Arizona resident. 
Section 1: Decedent Information                                     To obtain a certificate from the department, all of the following 
Enter the decedent's name, address and Social Security Number       must be met. 
(SSN).  
                                                                    1. A written request for a certificate must be submitted.  The 
Enter the estate's identification number, if applicable.  
                                                                       request  must contain a statement regarding the status of 
NOTE:  For a Grantor Trust, enter the Social Security Number           returns  filed by or on behalf of  the decedent or  for  the 
of the grantor, if not deceased                                        estate for the four taxable years immediately preceding the 
                                                                       date of the request.  The fiduciary must make the statement 
Enter the dates of the decedent's death and birth, and the date 
                                                                       under declaration of perjury.  The statement must indicate 
decedent established domicile in Arizona. If the decedent was a 
                                                                       the following: 
nonresident, describe the decedent's  Arizona  property on a 
separate  schedule.  If  applicable,  provide  the  name  of the       • the years for which returns were filed; and 
decedent's spouse, the spouse's  SSN, and, if deceased, the            • the  years for  which the  gross and Arizona taxable 
spouse's date of death.                                                  incomes  were less than the amount necessary to 
                                                                         require the filing of returns.                                 



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                                                                                                     Arizona Form 210 
2. A return was filed by or on behalf of the decedent and for 
   the estate  for each taxable  year in  which the respective     Mailing Form 210 
   incomes of the decedent or estate exceeded the                  DO NOT STAPLE ANY DOCUMENTS, SCHEDULES OR 
   requirements for filing returns.                                PAYMENT TO THE FORM 210. 
3. A final return (Form 141AZ) is filed when the certificate is    Mail your completed Form 210 to:  
   requested.  This return must be filed regardless of the gross    
   or net income  for the  year.   If there is no income, file a    Attention:  Fiduciary Unit 
   return with zero  "0" on all lines.                              Arizona Department of Revenue 
                                                                    Box B-06 
4. The fiduciary has filed Form 210. 
                                                                    1600 W Monroe  
Section 4: Estate Information                                       Phoenix, AZ 85007-2650 
Enter the approximate gross value of the decedent's entire           
estate. If the estate is being probated, also enter the            Contacting the Department’s Fiduciary Unit 
approximate  value of the probate estate. Enter  the name, 
address, and SSN of each individual beneficiary of the estate.     If you have any questions or need help with Form 210, call the 
If  the beneficiary is an entity enter the  name, address,  and    department at (602) 716-7809  or email  the Fiduciary  Unit at 
employer identification number (EIN).  For a non-fillable form,    www.Fiduciary@azdor.gov. 
enter the EIN using the format of an SSN.  For example, if the 
beneficiary is a trust and the EIN is 12-3456789, enter the EIN 
as 123-45-6789.   Include an extra sheet, if necessary. 
Section 5: Termination of Fiduciary Relationship 
Complete this section only if you are terminating a prior notice 
of assumption of duties in a fiduciary capacity on file with the 
department. 

Signature of Fiduciary 
Sign and date the completed Form 210.  Include  a title 
describing  your role as a fiduciary (executor, administrator, 
personal representative, etc.) 

Contacting the Department 
Tax information on file with the department is confidential. If 
the fiduciary wants the department to discuss tax matters with 
someone other than the fiduciary, the fiduciary must authorize 
the department to release  confidential information to  that 
person. Use Arizona Form 285 to do the following.  
•  Authorize  the department to release confidential 
   information to your appointee.  
•  Authorize an individual to represent or perform certain acts 
   on behalf of the entity. 
Form 285 may be filed with Form 210.   

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