The Affidavit for Collection of Personal Property in Arizona outlines the legal process for heirs to claim unclaimed property after a decedent's death. It requires detailed information about the decedent, including their name, date of death, and any valid wills or trusts. Heirs must provide their relationship to the decedent and may need to submit additional documentation, such as a death certificate. This form is essential for rightful heirs seeking to recover assets held by the Arizona Department of Revenue's Unclaimed Property Unit.

Key Points

  • Requires detailed information about the decedent, including name and date of death.
  • Heirs must provide their relationship to the decedent for property claims.
  • Includes sections for valid wills or trusts and personal representative appointments.
  • Essential for recovering unclaimed property held by the Arizona Department of Revenue.
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ADOR 10695 (4/25) Page 1 of 2
Previous ADOR 17-5509
Affidavit for Collection of Personal Property
Mail to: Arizona Department of Revenue • Unclaimed Property Unit • PO Box 29026 • Phoenix, AZ 85038
1
Please print or type your answers to each question:
1a.
Name of Decedent
1b. Date of Death
M M D D Y Y Y Y
1c.
Name of Decedent’s Spouse
Not married at time of death
1d. Spouse’s Date of Death
(if now decreased)
M M D D Y
Y
Y Y
Attach the decedent’s death certificate to this affidavit.
2
An answer for each question in Section 2 is required. Carefully read the instructions for questions answered, “Yes”.
2a. Did the decedent have a valid will as defined by
A.R.S. §§14-2501 to 2517?
No
Yes
If “Yes”, attach a complete copy of the valid will and trust
if one is mentioned in the will. Payment will be issued per
the terms of the will/trust.
2b. Is an application for appointment of personal representative pending,
or has a personal representative been appointed?
No
Yes
If “Yes”, only the assigned personal representative may
claim. Attach a copy of your Letters of Office certified
within 60 days.
2c. Was the value of all personal property in the decedent’s estate,
wherever located, less liens and encumbrances, valued above
$200,000 at the date of death or date of affidavit, pursuant to
A.R.S. §§14-3971(B)(2) to 14-3971(B)(2)(b)?
No
Yes
If “Yes”, the State of Arizona requires probate for this estate.
Attach the certified Decree of Distribution for a closed
estate or, once probate has been initiated, the personal
representative may claim; see 2b.
3
Choose one option in Section 3, and provide the requested information:
3a.
As a rightful heir of the decedent, I am claiming the payment of the decedent’s personal property held by the Arizona Department of
Revenue’s Unclaimed Property Unit that I am entitled to because of my relationship to the decedent of:
Your relationship to the decedent
3b.
I hereby unconditionally and irrevocably assign, grant, and transfer all rights, title, interest, and obligation in all unclaimed property held by
the Arizona Department of Revenue’s Unclaimed Property Unit in the name of the decedent to:
Name of heir you are assigning to
Each heir that wishes to assign their rights must fully complete this affidavit, choose option 3b, and name the heir they wish to
assign rights to. The heir accepting payment must file a claim and provide supporting evidence including their own affidavit.
4
Please print or type your answers to each question:
4a. Name of Decedent’s Descendants (children, grandchildren, etc.)
Decedent had no children
4b. Relationship
to Decedent
4c. Relationship
to You
4d. Date of Death
(
if now deceased)
To list more than six descendants, attach a page showing additional names.
Form must be signed and notarized.
!
ADOR 10695 (4/25) Page 2 of 2
Previous ADOR 17-5509
5
If the decedent was not survived by a spouse or descendants, provide the following parent information:
5a.
Name of Decedent’s Father
5b. Father’s Date of Death (if now decreased)
M M D D Y Y Y Y
5c.
Name of Decedent’s Mother
5d. Mother’s Date of Death (if now decreased)
M M D D Y Y Y Y
6
If the decedent was not survived by any family member previously listed, list in Section 6 the decedent’s parents’
descendants (siblings, nieces, nephews):
6a. Name of Decedent’s Parents’ Descendants
(children, grandchildren, etc.)
6b. Relationship
to Decedent
6c. Relationship
to You
6d. Date of Death
(
if now deceased)
To list more than four decedent’s parents’ descendants, attach a page showing additional names.
7
If the decedent was not survived by any family member previously listed, provide the following information:
7a.
Decedent’s Paternal Grandfather
Date of Death
7b. Decedent’s Maternal Grandfather
Date of Death
7c.
Decedent’s Paternal Grandmother
Date of Death
7d. Decedent’s Maternal Grandmother
Date of Death
8
If the decedent was not survived by any family member previously listed, list in Section 8 the decedent’s grandparents’
descendants (aunts, uncles, cousins):
8a. Name of Decedent’s Grandparents’ Descendants
(children, grandchildren, etc.)
8b. Relationship
to Decedent
8c. Relationship
to You
8d. Date of Death
(if now deceased)
To list more than four decedent’s grandparents’ descendants, attach a page showing additional names.
I swear and attest that all claims, assertions and signatures made in this affidavit are true and material, and I acknowledge that any false
statement in this affidavit may subject me to penalties related to perjury and the subornation of perjury.
Signature

Date
STATE OF )
COUNTY OF )
Subscribed and sworn before me this ____ day of _____________________,
20____, by:
PRINT NAME OF SIGNOR
(Notary Seal)
NOTARY PUBLIC
M M D D Y Y Y Y M M D D Y Y Y Y
M M D D Y Y Y Y M M D D Y Y Y Y
YOU MUST LIST BELOW ANY ADDITIONAL HEIRS AS DEFINED BY A.R.S. §§14-2102-14-2106.
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FAQs

What information is needed to complete the affidavit?
To complete the Affidavit for Collection of Personal Property, you need the decedent's full name, date of death, and details about their spouse if applicable. Additionally, information regarding any valid wills or trusts must be included, along with the relationship of the claimant to the decedent. If the decedent had no spouse or descendants, details about their parents and siblings may also be required.
What happens if the decedent's estate is valued above $200,000?
If the value of the decedent's personal property exceeds $200,000, Arizona law mandates that the estate undergo probate. In such cases, the affidavit cannot be used to claim property, and a certified Decree of Distribution must be attached to the claim. This ensures that the estate is properly administered according to legal requirements, protecting the rights of all heirs.
How can heirs assign their rights to unclaimed property?
Heirs can assign their rights to unclaimed property by completing the affidavit and selecting the appropriate option to assign their interests. Each heir must fully complete the affidavit and provide the name of the heir to whom they are assigning their rights. The heir receiving the assignment must then file a claim and submit supporting evidence, including their own affidavit, to the Arizona Department of Revenue.
What is the purpose of the affidavit?
The purpose of the Affidavit for Collection of Personal Property is to facilitate the transfer of unclaimed property to rightful heirs after a decedent's death. It serves as a legal document that verifies the claimant's relationship to the decedent and their right to claim the property. By providing necessary details and documentation, heirs can recover assets that may otherwise remain unclaimed.

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