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AFFIDAVIT OF PROPERTY OWNER’S LEASE TO CHURCH,
RELIGIOUS ASSEMBLY OR RELIGIOUS INSTITUTION
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 Church, Religious Assembly or Religious Institution
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 Church, Religious Assembly or Religious Institution and a copy of the complete
lease agreement, along with any other information the County Assessor may require.
I affirm that the Lessee Church, Religious Assembly or Religious Institution 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 Church, Religious Assembly or Religious Institution 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.
_________________________________________
___________________________________________
Property Owner’s Signature
Print Name (if different from above)
________________________________________
___________________________________________
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-R (Revised 12/2015)