SELF REPORT FORM

                     
BUSINESS NAME:      
                     
CARE OF NAME:      
                     
MAILING ADDRESS:     SUITE:    
                     
CITY:   STATE:   ZIPCODE:    
                     
CONTACT NAME:     CONTACT EMAIL:      
                     
CONTACT PHONE:     BUSINESS WEBSITE:      
                     
LOCATION ADDRESS:     SUITE:    
                     
CITY:     ZIPCODE:    
                     
PARCEL #     TYPE OF BUSINESS:    
                     
FEIN #          
                     
DATE STARTED AT THIS LOCATION:     DAY:   MONTH:   YEAR:      
                     
OTHER LOCATIONS IN ARIZONA, (INCLUDE ACCOUNT #'S) :                 ( ATTACH LISTING FOR MORE LOCATIONS )  
                     
   
                     
   
                     
   
                     
   
                     
NAME OF COUNTY IN WHICH YOU ARE CLAIMING EXEMPTION:                
( EACH ELIGIBLE TAXPAYER IS ENTITLED TO ONE STATEWIDE EXEMPTION )                    
                     
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Business Personal Property Taxes in Arizona are a lien against the Equipment as well as the                    
Owner. Report all equipment for the current Tax Year which was owned by your business as of                    
December 31st, of the prior year. Please attach a copy of your asset listing with this                    
Self-Reporting Form. If your business does not maintain a fixed asset listing, please use the                    
attached page to list all equipment owned by your business, and operated at the above listed                    
new location. For Multiple locations see the E-Filing Statement on the Assessor's Personal                    
Property Website.                    
                     
Please direct all questions concerning the above to the Maricopa County Assessor's Office,                    
Personal Property Division at 602-506-3386. Fax number: 602-506-7335                    
                     
Complete this form and mail all information to:                    
                     
    MARICOPA COUNTY ASSESSOR'S OFFICE                
    PERSONAL PROPERTY DIVISION                
    301 W JEFFERSON ST, SUITE 330                
    PHOENIX, AZ 85003-2196                


SELF REPORT ASSET LISTING

         
BUSINESS NAME: CONTACT PERSON: .
LOCATION: CONTACT PHONE: .
Acquisition   Acquisition Assessor Use Only
Cost Description Year Class Code
         




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