Form Dor 82520 - Arizona Business Property Statement - 2011 Page 2
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22011 ARIZONA BUSINESS PROPERTY STATEMENT
SHADED AREAS FOR ASSESSOR’S USE ONLY
BUSINESS NAME _________________________________________________________________ TAXPAYER / ACCOUNT NUMBER ___________________
SECTION 3:
CLASS
CLASS
CLASS
CLASS
CLASS
CLASS
CLASS
CLASS
CLASS
ASSESSOR’S
B
C
D
A
E
G
J
Q
I
USE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
ONLY
SECTION 4:
ADDITIONS AND DELETIONS: ENTER YOUR ACQUISITION COST IN THE APPROPRIATE SCHEDULE FOR PROPERTY ACQUIRED DURING THE PRIOR YEAR
WHICH YOU OWNED ON 12/31/2010. ENTER YOUR ACQUISITION COST IN THE APPROPRIATE SCHEDULE AND THE YEAR OF ACQUISITION FOR ALL
PROPERTY DELETED DURING THE PRIOR YEAR.
SCHEDULE
A
B
C
D
E
G
I
J
Q
YEAR OF
OFFICE
STORE, MOTEL
MACHINERY
SPECIAL
COMPUTER
SUPPLIES
CONSTRUCTION
COPYING
NUMBER OF
FURNITURE
TOOLS
APARTMENT
AND
EQUIPMENT
ON HAND
EQUIPMENT
EQUIPMENT
RENTAL VIDEO
ADDITIONS OR
AND
DIES AND
FURNITURE
DECEMBER 31
EQUIPMENT
TAPES
DELETIONS
JIGS
EQUIPMENT
AND FIXTURES
ADDITIONS:
YEAR
QUALIFIED
NON-QUALIFIED
QUALIFIED
NON-QUALIFIED
DELETIONS:
YEAR
20 ______
20 ______
20 ______
20 ______
20 ______
20 ______
20 ______
20 ______
20 ______
20 ______
19 ______
ACQUISITION
ADDITION OR
TABLE
ACQUISITION
YEAR
DESCRIPTION
LIFE
COST
DELETION
NO
Qualifi ed
Qualifi ed
SCHEDULE F: OTHER PROPERTY
Non-Qualifi ed
Non- Qualifi ed
Qualifi ed
SCHEDULE H: LEASEHOLD
Qualifi ed
IMPROVEMENT
Non-Qualifi ed
Non-Qualifi ed
SECTION 5: ADDITIONAL INFORMATION REQUIRED.
LEASED OR RENTED PROPERTY: Attach a list of all leased or rented property in your possession.
UNOWNED PROPERTY: Attach a list of property located at your place of business which you do not own, lease, or rent.
GOVERNMENT OWNED LAND: If located on government property, attach a list providing the government owner’s name and address.
SECTION 6: AFFIRMATION OF PROPERTY STATEMENT AND CLAIM OF EXEMPTION
By signing below, I hereby affi rm that this is a full, true, and complete statement of property that is claimed by, or that is in the possession or control of the undersigned,
and it is verifi able from records and fi les of the above named business. The person whose signature is affi xed below likewise claims an exemption amount not
to exceed the fi rst $67,268 of full cash value. Each eligible taxpayer is entitled to one statewide exemption.
_________________________________________________
______________________
___________________________________________
Print Name of Property Owner or Authorized Agent
Date
Name of County in which you are Claiming Exemption
_________________________________________________
______________________
Signature of Property Owner or Authorized Agent
Phone
SUPPLEMENTAL INFORMATION ATTACHED? YES
NO
TAXPAYER: RETURN ORIGINAL FORM AND COPY BOTH SIDES FOR YOUR FILES
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