Form Dor 82620 - Government Property Lease Excise Tax (Gplet) Return Form
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GOVERNMENT PROPERTY LEASE EXCISE TAX (GPLET) RETURN FORM
FOR CALENDAR YEAR / TAX YEAR 20
Pursuant to A.R.S. §§ 42-6201 through 42-6210
For County Treasurer's Use Only.
Date Received:
Penalty Due: Yes
No
Government Lessor (the property owner) must complete Items 1 – 11:
1.
Government Lessor:
Name: ________________________________________________ E-Mail: ________________________________________
Address: ______________________________________________________________________________________________
Phone: ____________________________________
Contact Person: ___________________________________________
2.
Subject Government Property Improvement:
Property’s Name (if applicable):
Assessor’s Parcel Number:
Street Address:
Multiple parcels check here:
and attach list.
3.
Prime Lessee:
Name:
E-Mail:
Phone:
Address: ________________________________________________________________________________________________
4.
The date of issuance of the original Certificate of Occupancy for the leased improvement is:
5.
Lease Origination Date:
Lease Termination Date:
6.
Has the lease been amended since the last return was filed?
Yes
No
If yes, attach a separate statement detailing the amendment(s) or attach a copy of the amended lease to this return form.
7.
Is there a predominate use of the government property improvement subject to your lease?
Yes
No
If yes, select the appropriate use below and enter the gross building space or total square footage subject to the lease and the
number of parking spaces included in the lease that are located within a parking garage or deck (if applicable).
If a predominant use cannot be identified, select all of the uses subject to the lease and enter the square footage devoted to each
use.
(If additional space is needed, attach a separate page.)
1 story office structure
Gross Building Space ___________
Number of Parking Spaces _________
(Column 5)
2 to 7 story office structure
Gross Building Space ___________
Number of Parking Spaces _________
(Column 6)
8 or more story office structure
Gross Building Space ___________
Number of Parking Spaces _________
(Column 7)
Retail structure
Square Footage ___________
Number of Parking Spaces _________
(Column 8)
Hotel/Motel structure
Square Footage ___________
Number of Parking Spaces _________
(Column 9)
Warehouse/Industrial structure
Square Footage ___________
Number of Parking Spaces _________
(Column 10)
Residential-Rental structure
Square Footage ___________
Number of Parking Spaces _________
(Column 11)
All others
Square Footage ___________
Number of Parking Spaces _________
(Column 12)
Parking Garage or Deck (structure only)
Number of Parking Spaces _________
(Column 13)
8.
Is this an initial return? (i.e., is this the first time that a return has been filed) Yes
No
If yes, and if a "certified statement" of gross building space or total square footage and/or the total number of parking places,
as applicable has been obtained, submit a copy of that certified statement with the return form.
9.
Is the Prime Lessee claiming that the use of the leased property is exempt from the excise tax pursuant to A.R.S. § 42-6208, as
indicated by one of the paragraphs numbered 1 through 15 on Page 2 of the return form?
Yes
No
If yes, indicate the applicable paragraph number here:
10. Is the Prime Lessee currently subject to an abatement of the Excise Tax? Yes
No
If yes, the abatement was approved on:
and the abatement terminates on:
By signing this form below, the Prime Lessee certifies, under penalty of perjury, that (a) the “gross building space”, or the total
square footage, and/or the total number of parking spaces, as applicable, has not changed from the previous year’s reported
figures, and (b) that if the lease is subject to abatement, all elements necessary to qualify for the excise tax abatement are satisfied
for the current calendar year/tax year.
Signature
Date
11. Total excise tax amount = $
(calculated amount from worksheet)
The tax is due and payable to the County Treasurer on or before December 1 of each calendar year.
Tax amount was calculated using which Rate Chart?
A
or
B
Attach a copy of the completed Worksheet to this Return
and submit copies to both the County Treasurer and the Prime Lessee.
The Prime Lessee should retain a copy of the Return form and the Worksheet utilized (and any other attachments) for their records.
DOR 82620 (09/2017)
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