Dor Form 82061-C - Property Tax Form - Small Scale Mines - 2014 Page 9

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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
LEASED LANDS SCHEDULE
Operation __________________
County of __________________________
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LEASE TYPE
|
DESCRIPTION &
LOCATION
|
ACREAGE
|
ANNUAL PAYMENT
|
TERM OF LEASE
|
SECTION,TOWNSHIP,RANGE
|
|
|
IN YEARS
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SCHEDULE OF LEASED EQUIPMENT
__________________________________________________________________________________________________
Description
|
Use
|
Year
|
Year
|
Serial
|
Original
|Annual Lease
of Equipment
|
| Acquired |
Built |
Number
| Cost of Item |
Payment
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_____________________|_______|__________|________|_________________|______________|______________
DOR Form 82061-C (Rev. 11-12)
PAGE A9 OF A12

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