Form Dor 82916 - Agricultural Land Use Application Page 2
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1
2AGRICULTURAL LAND USE APPLICATION
ASSESSOR'S USE ONLY
File Date: _____________
County: _________________
Agricultural Unit Number: __________________
OWNER:
NAME & ADDRESS - PLEASE PRINT
Check here if you are choosing the Quick File Option
(See the instructions)
Totals: Parts A, B & C
(combined)
Listing of Agricultural Land
Agricultural Land -- Total Acres
-- Annual AUM's
Carrying Capacity
Use Continuation Page(s) (form DOR 82916-C) if necessary
See instructions for carrying capacity pertaining to grazing land
A.
Deeded Land You Own
Land Parcels
ASSESSOR'S USE ONLY
Land Use
Acres
Homesite
Item #
Acreage
Assessor's Parcel ID Number
(see codes)
(AG Land)
Parcel Size
App
Den
PUC
1
2
3
4
If located in a different county than
B.
Deeded Land Leased to You
the land in Part A, which county?
Land Parcels
Acres
Lease Term Dates
Land Use
Owner's Name
Item #
Leased
(see codes)
Assessor's Parcel ID Number
Begin
End
1
2
3
C.
Carrying
Government Land Leased to You
(or subleased to you)
Capacity
Lease Term Dates
Annual
Gov't Agency
Lease ID
e.g. BLM,
e.g. Lease Number,
Acres
Item #
AUM's
Forest Service, State Land Dept.
Permit #, Allotment # / Name
Begin
End
1
2
3
Affirm and Attest
Before marking the checkboxes here, you are advised to read the Agricultural Property Classification statutes set forth in
Note: If you leave any
A.R.S. Title 42, Chapter 12, Article 4. Online source:
boxes unchecked, you must provide an explanation on a separate sheet of paper and attach it to your application.
1. I hereby affirm this is a true and complete statement, to the best of my knowledge, of the property that is owned,
claimed by, or in possession or control of the undersigned.
2. I hereby affirm that the property meets the requirements prescribed in A.R.S. § 42-12152, “Criteria for classification
of property used for agricultural purposes”.
3. I affirm and attest that the property is in active production with an expectation of profit.
____________________________________________
____________________________________
__________________
Signature of Owner or Representative
Date
Print Name (and title, if applicable)
Telephone
State Board of Appraisal # _________________
___________________________________________
(for Property Tax Agents only)
Email address
Include a current Agency Authorization (82130AA)
DOR 82916 (04/2013)
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