Holder Reimbursement Request Form

After a report is submitted, a holder may choose to repay the owner directly or may determine that items within the report were filed in error. In these cases, the holder may seek reimbursement by submitting the Holder Request for Reimbursement form (Arizona Form 670) along with the required documentation substantiating the repayment or error. Please use the current version, 670 revised 09/09. All other forms are obsolete and will not be accepted.