Form Dor 82009-S - Affidavit Of Property Owner'S Lease To Charter School

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AFFIDAVIT OF PROPERTY OWNER’S LEASE TO CHARTER SCHOOL
A.R.S. § 42-12009(A)(5).
Date: ______________________________
Tax Year: _____________________________________
Parcel Number(s): ________________________________________________________________________
Personal Property Account Number: __________________________________________________________
Property Owner’s Name: __________________________________________________________________
Property Owner’s Mailing Address: ___________________________________________________________
Owner’s Telephone Number ___________________
Email Address: ______________________________
Tenant’s/Lessee’s Name: ___________________________________________________________________
Tenant’s/Lessee’s Mailing Address: ___________________________________________________________
Address of Property: ______________________________________________________________________
Gross Leasable Building Space: _____________________________________________________________
Amount of Gross Leasable Building Space leased to the
Charter School as of January 1 of the Tax Year: __________
____
Date of Lease Agreement: ___________________
Lease Term: Begin Date ____________________
End Date _______________________
I hereby request that the Property that is occupied and used by the Lessee be reclassified by the County Assessor
as Class Nine property pursuant to A.R.S. § 42-12009(A)(5).
If requested, I agree to provide, or will request that the Lessee provide, the County Assessor with proof of the
nonprofit status of the Lessee Charter School and a copy of the complete lease agreement, along with any other
information the County Assessor may require.
I affirm that the Lessee Charter School shall be the sole beneficiary of any reduction in real property taxes resulting
from this reclassification of the Property, or that portion of it which qualifies, as a result of the Property’s exclusive
use as a Charter School for the entire valuation year. In addition, I certify that the lease rate that is charged to the
Lessee is consistent with the lease rates that are charged to other tenants of the Property or a fair market rate.
__________________________________________
________________________________________
Name of Property Owner/Agent (please print)
Property Owner’s/Agent’s Signature
_________________________________________________________
___________________________
Signature of Deputy Assessor/Notary
Date My Commission Expires
A new Affidavit must be filed with the County Assessor whenever there is a change in the
terms of the lease involving this property.
DOR 82009-S (Revised 12/2015)

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