ANNUAL AFFIDAVIT OF A CHURCH, RELIGIOUS ASSEMBLY OR
INSTITUTION USING OR HOLDING LEASED PROPERTY
PRIMARILY FOR RELIGIOUS WORSHIP
A.R.S. § 42-11132.01
A.R.S. § 42-11132.01(A) requires that a church, religious assembly or institution leasing property that is classified in Class
Nine pursuant to A.R.S. § 42-12009(A)(5), must annually file an affidavit with the County Assessor affirming that it:
1. Continues to use or hold the property primarily for religious worship.
2. Is the sole economic beneficiary of the classification of the property as Class Nine pursuant to Section 42-12009,
Subsection A, Paragraph 5.
Tax Year: _________________
Parcel Number(s): _______________________________________________________________________
Personal Property Account Number(s): _______________________________________________________
Property Owner’s/Lessor’s Name: ___________________________________________________________
Property Owner’s/Lessor’s Mailing Address: ___________________________________________________
Owner’s Telephone Number ___________________
Email Address: _____________________________
Tenant’s/Lessee’s Name: __________________________________________________________________
Tenant’s/Lessee’s Mailing Address: __________________________________________________________
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 begin Date: __________
Lease End Date: __________
I affirm that the Church, Religious Assembly or Religious Institution identified above, continues to use or hold
the leased property described above primarily for religious worship and that the Church, Religious Assembly
or Religious Institution continues to be the sole economic beneficiary of the property as Class 9 pursuant to
A.R.S. § 42-12009(A)(5).
Signature of Deputy Assessor/Notary
Date My Commission Expires
This Affidavit must be filed with the County Assessor on an annual basis.
DOR 82132 (Revised 12/2015)