Form Dor 82520 - Arizona Business Property Statement - 2004 Page 2
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22004 ARIZONA BUSINESS PROPERTY STATEMENT
SHADED AREA FOR ASSESSOR’S USE ONLY
BUSINESS NAME:_______________________________________________________________________ TAXPAYER/ACCOUNT NUMBER:_____________________________
SECTION 3
CLASS
CLASS
CLASS
CLASS
CLASS
CLASS
CLASS
CLASS
CLASS
ASSESSOR’S
A
B
C
D
E
G
I
J
Q
USE
ONLY
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
TBL #
LIFE
SECTION 4: ADDITIONS AND DELETIONS: ENTER YOUR ACQUISITION COST IN THE APPROPRIATE SCHEDULE FOR PROPERTY ACQUIRED DURING THE PRIOR YEAR
WHICH YOU OWNED ON 12/31/2003. ENTER YOUR ACQUISITION COST IN THE APPROPRIATE SCHEDULE AND THE YEAR OF ACQUISITION FOR ALL
PROPERTY DELETED DURING THE PRIOR YEAR.
A
B
C
D
E
G
I
J
Q
SCHEDULE
STORE ,MOTEL,
YEAR OF
OFFICE
SUPPLIES ON
NUMBER OF
APARTMENT
MACHINERY AND
SPECIAL TOOLS
COMPUTER
CONSTRUCTION
COPYING
ADDITIONS OR
FURNITURE AND
HAND DECEMBER
RENTAL VIDEO
FURNITURE &
EQUIPMENT
DIES & JIGS
EQUIPMENT
EQUIPMENT
EQUIPMENT
EQUIPMENT
31
TAPES
DELETIONS
FIXTURES
ADDITION:
YEAR
QUALIFIED
NON-QUALIFIED
QUALIFIED
NON-QUALIFIED
DELETIONS: YEAR
20_____
20_____
20_____
19_____
19_____
19_____
19_____
19_____
19_____
19_____
ACQUISITION
ADDITION OR
TABLE
ACQUISITION
YEAR
DESCRIPTION
COST
DELETION
NO.
LIFE
Qualified
Qualified
SCHEDUKE F: OTHER
Non-Qualified
PROPERTY
Non-Qualified
Qualified
Qualified
SCHEDULE H: LEASEHOLD
Non-Qualified
IMPROVEMENT
Non-Qualified
SECTION 5: ADDITIONAL INFORMATION REQUIRED:
LEASED OR RENTED PROPERTY: Attach a list of all leased or rented property in your possession.
UNKNOWN OR RENTED 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 herby affirm that this is a full, true, and complete statement of property claimed by, in the possession or control of the undersigned and it is
verifiable from records and files of the above named business. The person whose signature is affixed below likewise claims an exemption amount not to
exceed the first $56,298 of full cash value.
Print name of property owner or authorized agent
Date
(
)
Signature of property owner or authorized agent
Phone
SUPLEMENTAL INFORMATION ATTACHED? YES ________ NO __________
TAXPAYER: RETURN ORIGINAL FORM AND COPY BOTH SIDES FOR YOUR FILES
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