Dor Form 82061-C - Property Tax Form - Small Scale Mines - 2014 Page 3

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BY SIGNING THE VERIFICATION PAGE, THE TAXPAYER WAIVES THE CONFIDENTIALITY REQUIREMENTS OF A.R.S.
SECTION 42-2001 THROUGH 42-2OO4 WITH RESPECT TO THIS PAGE AND CONSENTS TO THE DISCLOSURE OF THE
CONTENTS OF THIS PAGE TO COUNTY ASSESSOR PERSONNEL BY THE DEPARTMENT OF REVENUE.
SMALL SCALE MINES
Company Name_______________________________
For the Year Ended December 31, 2012
PROPERTY LIST - OPERATING LAND
Indicate type of land by letter designation---P for patented claims and fee land, U for
unpatented land, S for severed mineral rights, L for leased land, R for rights-of-way, and
O for other ownership rights. Entries should include any and all lands acquired during the
year that are not listed on the accompanying copy of the DOR land printout(PS 1220-12).
___________________________________________________________________________________________
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COUNTY
| BOOK | MAP | PARCEL |
TAX CODE
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TYPE
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ACRES
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LEGAL DESCRIPTION
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|____________|______|_____|________|____________|________|_________|_______________________|
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|____________|______|_____|________|____________|________|_________|_______________________|
DOR Form 82061-C (Rev. 11-12)
PAGE A3 OF A12

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