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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.                    Enter the fiduciary’s name, address, and telephone number.  
Income Tax Procedures and Rulings                                   If the fiduciary is an entity, include the  name and phone 
                                                                    number of an individual for contact purposes regarding non-
These instructions may refer to the department’s income tax 
                                                                    confidential tax matters.  
procedures and rulings for more information.  To view or print 
these, go to our website and click on  Reports and Legal            If a fiduciary wishes to authorize an individual to represent or 
Research  then click on Legal Research and select a Document        perform certain acts on behalf of the entity, a Power of 
Type and Category from the drop down menus.                         Attorney must be filed and signed by the fiduciary acting in the 
                                                                    position of the taxpayer.  Use Arizona Form 285 for this 
Publications                                                        purpose.  Form 285 may be filed with Form 210.  
To view or print the department’s publications, go to our 
                                                                    If the fiduciary has a foreign address, enter the information in 
website and click on Reports and Legal Research then click on 
                                                                    the following order:  city, province  or state, and country.  
Publications. 
                                                                    Follow the country’s practice for entering the postal code.   Do 
                                                                    not abbreviate the country name. 
Purpose of Form 
                                                                    Section 3: Probate Information 
Use Form 210 to notify the Arizona Department of Revenue of 
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.  
                                                                    •    Enter the name of the county in which probate proceedings 
• an executor, 
                                                                         are being conducted.  
• an administrator,                                                 •    Enter the probate number, the date of the fiduciary's 
• a personal representative, or                                          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 
                                                                    a Certificate of Payment of Taxes from the department that 
The fiduciary should file Form 210 to notify the department of      shows no income tax is due. The probate court may require this 
either of the following:                                            certificate before approving the fiduciary's final account. 
• the creation of a fiduciary relationship for a decedent's         Arizona law requires a certificate only when        all  of the 
  estate, or                                                        following apply: 
• the termination of a fiduciary relationship for a decedent's      1.   The estate is subject to probate. 
  estate. 
                                                                    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             must be met. 
Number (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   If you have any questions or need help with Form 210, call the 
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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