
B. Bank deposits
C. Securities
D. Other assets (household furnishings,
automobiles, other personal property)
E. Insurance
Total value of the estate
(Add A through E)
Report of Personal Representative of Decedent
This report must be completed and returned to:
74
ARIZONA
FORM
Estate Tax Unit, Arizona Department of Revenue,1600 W Monroe, Room 610, Phoenix AZ 85007-2650
For assistance call: (602) 542-4643 or (800) 352-4090 (nationwide toll free)
Personal representative
Attorney
Please Print or Type
Name of decedent (last, first, middle initial)
Residence of decedent (city or town, state, and ZIP code)
ADOR 06-0034 (99)
Complete page 2
Attach a copy of the death certificate if this is an original report.
Section II
Section I
Complete Section III first. Enter values below. (See instructions)
Arizona
A. Real estate
Other
Than Arizona
$
$
$
$
$
$$
Is a federal estate tax return (Form 706 or 706NA) being filed? NO YES
Indicate the type of waiver(s) you are requesting
Summary of Estate
Documents Requested
Section III
A. Real Estate - Market value at date of death of all real estate in Arizona. $ _______________________.
Use a continuation sheet if more space is needed
Estate Assets
Estate's federal identification number
Decedent's social security number
Date of death
Probate number (if any)
County of Probate Court
CHECK ONE
Original Amended
$
$
$
$
$
List legal description(s) of real estate in Arizona. Indicate county and if held as separate or joint tenancy.
This can be found on the deed to the property or on the notice of valuation from the county assessor's
office. Note, be sure to include the lot number and subdivision name.
Estate tax waiver (Real Estate)
Estate tax waiver (Probate)
You may also visit our web site at: www.revenue.state.az.us
Address City State ZIP code
Address City State ZIP code