RETURN TO:
2009 ARIZONA
ASSESSOR’S USE ONLY
BUSINESS
PAMELA J. PEARSALL
13
PROPERTY STATEMENT
YAVAPAI COUNTY ASSESSOR
1015 FAIR STREET
PRESCOTT, AZ 86305
THIS STATEMENT IS CONFIDENTIAL AND
TAXPAYER / ACCOUNT NUMBER
LOC
CK
IS SUBJECT TO AUDIT BY THE ASSESSOR.
FAILURE TO COMPLETE AND RETURN BY
(928)771-3220
FAX (928)771-3181
THE REQUIRED DATE WILL RESULT IN
A PENALTY OF TEN PERCENT OF THE
COMPLETE IN FULL AND RETURN TO ASSESSOR
AMOUNT OF TAXES DUE, PURSUANT TO
NEW TAXPAYER
A.R.S. § 42-15053(F)(2).
APRIL 1, 2009
BY:
MAILING DATE
PROPERTY LOCATION:
AREA CODE:
PARCEL:
AREA CODE
BOOK
MAP
PARCEL
SPL
CK
DO NOT MAKE CHANGES IN ADDRESS AREA - SEE SECTION 1 BELOW
PRORATE
AP
10% PENALTY
IMPORTANT - READ FIRST! Before completing this form, please read the instructions
YES
for information on reporting requirements and the amount of exemption.
SIGN SECTION 6 TO CLAIM THE EXEMPTION.
SECTION 1: COMPLETE THIS SECTION ONLY IF THIS IS A NEW BUSINESS OR IF THERE IS A CHANGE IN NAME AND / OR ADDRESS.
1. BUSINESS NAME ___________________________________________ C / O ____________________________________________________________
2. ADDRESS ____________________________________________________________ CITY _____________________ STATE ______ ZIP ___________
3. PROPERTY LOCATION ADDRESS ________________________________________ CITY ____________________ STATE
AZ
ZIP ___________
4. BUSINESS TYPE (Manufacturing, Offi ce, Restaurant, etc.) ______________________________________ PRODUCT_____________________________
5. DATE STARTED IN THIS COUNTY ______________ CONTACT PERSON ___________________________________ PHONE ____________________
SECTION 2: DO NOT MAKE CORRECTIONS IN THIS SECTION. MAKE ALL CHANGES, ADDITIONS OR DELETIONS TO PROPERTY
COST LISTED BELOW IN SECTION 4. THE ACQUISITION COST OF PROPERTY REPORTED LAST YEAR IS LISTED BELOW BY
SCHEDULE AND YEAR ACQUIRED.
SCHED.
YEAR
ACQUISITION COST
CLASS
CODE
SCHED.
YEAR
ACQUISITION COST
CLASS
CODE
TAXPAYER: RETURN ORIGINAL FORM AND COPY BOTH SIDES FOR YOUR FILES
DOR 82520 (REVISED 10/08)