Form 82901 - Notification Of Arizona Residential Rental Property
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2NOTIFICATION OF ARIZONA RESIDENTIAL RENTAL PROPERTY
Pursuant to A.R.S. §§ 33-1901 and 33-1902 (see next page)
INSTRUCTIONS: In compliance with A.R.S. § 33-1902(A): an owner of residential rental property shall maintain with the Assessor
in the county where the property is located information required by this section in a manner to be determined by the Assessor.
Pursuant to A.R.S. § 33-1902(B): an out-of-state owner of residential rental property shall designate and record with the County
Assessor a statutory agent who lives in this state and who will accept legal service on behalf of the owner. If the property is
owned by a corporation, limited liability company, partnership, trust or real estate investment trust, include the name, address
and telephone number of the business entity and the statutory agent. A person who fails to comply with any provision of this
section shall be assessed a civil penalty of one thousand dollars, plus an additional one hundred dollars for each month after
the date of the original violation until compliance occurs. RETURN COMPLETED FORM TO THE ASSESSOR OF THE COUNTY
IN WHICH THE PROPERTY IS LOCATED, AND RETAIN COPIES FOR YOUR RECORDS.
PROPERTY INFORMATION FOR COUNTY (required).
List name of county here:
Check property type:
Single Family Residence
Multiple Family Residence
Mobile Home
MH / RV Park Space
Property Address: _______________________________________ City / State / Zip Code: __________________________________
The following information shall be maintained: the name, address and telephone number of the property owner.
List Additional Parcel Numbers (up to four):
Primary Assessor’s _______ _______ _________ _______
Parcel Number
Book
Map
Parcel
Split
For Unsecured Mobile Homes
List Assessment Account Number:
List the year the building was built:
(ATTACH LIST FOR ANY ADDITIONAL PARCELS)
OWNERSHIP INFORMATION:
NAME OF PROPERTY OWNER / BUSINESS ENTITY:
Check below to indicate form of ownership and provide statutory agent, if applicable:
Property owner, list owner(s) and statutory agent residing in Arizona (required for out-of-state property owners):
Corporation, list corporate offi cer and statutory agent:
Limited liability company, list managing or administrative member and statutory agent:
Partnership, list general partner and statutory agent:
Limited partnership, list general partner and statutory agent:
Trust, list trustee and statutory agent:
Real estate investment trust, list general partner or offi cer and statutory agent:
Provide telephone number and address for property owner(s) / business entity: Telephone number:
Address:
City:
Zip Code:
E-Mail Address
Provide telephone number and address (no P.O. box) for statutory agent: Telephone number:
Address:
City:
Zip Code:
E-Mail Address
REQUIREMENT TO UPDATE INFORMATION:
Under penalty of law the owner of Arizona residential rental property shall update any information listed above within ten days
after a change in the information occurs.
I hereby affi rm that the information included or attached is true and correct.
Print Name
Print Title
Signature
Date
82901 (Rev. 12/05)
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