INSTRUCTIONS: ARIZONA COLLECTION INFORMATION STATEMENT (PERSONAL) (Form 10896)

Arizona residents who owe money to the state they are unable to pay should file a form 10896. This collection information statement can be obtained from the website of the Arizona Department of Revenue.

Arizona Collection Information Statement (Personal) 10896 Step 1: Section 1 concerns personal information. You should enter your name, date of birth and Social Security number, as well as the same information for your spouse if applicable.

Arizona Collection Information Statement (Personal) 10896 Step 2: Enter your marital status, street address, county of residence, length of residence at your current address and home phone number.

Arizona Collection Information Statement (Personal) 10896 Step 3: List all dependents, give their relationship to you and indicate whether they live with you.

Arizona Collection Information Statement (Personal) 10896 Step 4: Section 2 concerns any business you or your spouse operate or if you or your spouse are self-employed. If so, provide all information requested.

Arizona Collection Information Statement (Personal) 10896 Step 5: Section 3 requires you to provide employment information for you and your spouse.

Arizona Collection Information Statement (Personal) 10896 Step 6: Section 4 concerns other forms of income. If you have any, you must attach supporting documentation.

Arizona Collection Information Statement (Personal) 10896 Step 7: Section 5 requires you to provide information about you or your spouse's bank accounts, investments, cash on hand, available credit, and life insurance policies. If additional space is needed, a supplemental page for documentation is provided on the last page of this packet.

Arizona Collection Information Statement (Personal) 10896 Step 8: Section 6 requires you to state how much you owe in federal taxes, if anything, as well as money owed to any other government agency.

Arizona Collection Information Statement (Personal) 10896 Step 9: Section 7 requires you to provide answers to miscellaneous questions.

Arizona Collection Information Statement (Personal) 10896 Step 10: Section 8 requires you to detail your assets and liabilities, including purchased and leased automobiles and trucks, real estate and personal assets such as furniture and jewelry.

Arizona Collection Information Statement (Personal) 10896 Step 11: Section 9 requires you to detail total monthly income and expenses.

Arizona Collection Information Statement (Personal) 10896 Step 12: You and your spouse should sign and date the bottom of the fourth page.