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2012 ARIZONA
PAMELA J. PEARSALL
ASSESSOR’S USE ONLY
AGRICULTURAL
YAVAPAI COUNTY ASSESSOR
BUSINESS
1015 FAIR STREET
PROPERTY STATEMENT
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
COMPLETE IN FULL AND RETURN TO ASSESSOR
THE REQUIRED DATE WILL RESULT IN
A PENALTY OF TEN PERCENT OF THE
AMOUNT OF TAXES DUE, PURSUANT TO
APRIL 1, 2012
BY:
NEW TAXPAYER
A.R.S. § 42-15053(F)(2).
MAILING DATE
AREA CODE
BOOK
MAP
PARCEL
SPL
CK
DO NOT MAKE CHANGES IN ADDRESS AREA - SEE SECTION 1 BELOW
10% PENALTY
PRORATE
AP
IMPORTANT - READ FIRST! Before completing this form, please read the instructions
for information on reporting requirements and the amount of exemption.
YES
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. FARM OR RANCH NAME _______________________________________ C / O __________________________________________________________
2. ADDRESS __________________________________________________________ CITY ____________________ STATE
ZIP ____________
3. PROPERTY LOCATION ADDRESS ______________________________________ CITY ____________________ STATE
AZ
ZIP _____________
4. TYPE OF AGRICULTURAL PRODUCTION _________________________________________________________________________________________
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 82520A (REVISED 11/2011)