Form Dor 82300 - Income And Expense Statement And Affidavit
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1INCOME AND EXPENSE STATEMENT
CHECK PROPERTY TYPE:
AND AFFIDAVIT
APARTMENT
MOBILE HOME / RV PARK
OFFICE / RETAIL STORE
MINI-STORAGE WAREHOUSE
HOTEL / MOTEL / RESORT
IND. MFG / WHSE / MULTI-PURPOSE
SHOPPING CENTER
Pursuant to A.R.S. §§ 42-16052 and 42-16107: A petition that is fi led with the Assessor based on the income approach to value shall include income and
expense data relating to the property for the three most recent consecutive fi scal years of the petitioner ending on or before September 30 of the previous
year. If the income and expense data are not available to the petitioner, the petitioner shall fi le with the petition such income and expense data as are
available. The evidence permitted in an appeal relating to a petition based on the income approach to value is limited to the income and expense
data fi led with the petition, the testimony of the petitioner and any witnesses presented on the petitioner’s behalf, and evidence presented by the
Assessor and the Arizona Department of Revenue.
INSTRUCTIONS: THIS FORM AND THE APPROPRIATE INCOME AND EXPENSE REPORTING FORM MUST ACCOMPANY THE
PETITION FOR REVIEW FILED WITH THE COUNTY ASSESSOR.
NOTE: The information submitted is confi dential and is to be utilized only by the Valuation Authorities. Valuation Authorities include,
but are not limited to, the County Assessor and the Arizona Department of Revenue. This form must be completed and fi led with the
original appeal form. Information submitted on the reporting forms must be only actual income and expenses for the property under
appeal. Other data used to justify the owners opinion of value, including a profi t and loss statement, a property pro-forma statement or
any similar evidence may be submitted on a separate sheet(s) as supplemental data. The County Assessor may also request additional
information to verify the data submitted with the appeal. Contact the County Assessor if you have any questions on the use of this
statement or the reporting forms.
•
Retain a copy of this form and any supplemental data submitted.
•
Complete the market approach and / or cost approach information sections below only if the property has been purchased or constructed
within the past three years.
•
Complete the income and expense reporting form information as applicable for the type of property under appeal and sign the Affi davit
section below.
•
The Affi davit section below must be signed by the property owner, an offi cial of the fi rm authorized by the owner or a property tax agent
designated by the owner to act on his behalf.
PRINT OR TYPE:
DATE: __________
COUNTY _______
BOOK _____
MAP _____
PARCEL _______
OWNER’S NAME
OWNER’S ADDRESS
____________________________________
CITY _________________________ STATE ___________ ZIP _________
TELEPHONE _________________________
PROPERTY ADDRESS / SITUS
_____________________________________________________________________________________________
IS THIS A MULTI-PARCEL APPEAL? YES
NO
IF YES, ATTACH A LIST OF THE OTHER PARCELS (DOR FORM 82131).
PRIOR YEAR PROPERTY TAXES $ ____________ (IF A MULTIPLE PARCEL APPEAL, THE TOTAL TAXES FOR ALL PARCELS.)
MARKET DATA
DATE OF
COST APPROACH
DATE OF
SALES
PURCHASE
DATA
PURCHASE
PURCHASE AMOUNT
$ _____________
__________
LAND COST
$ _____________
_________
_________
LESS PERSONAL PROPERTY
_____________
IMPROVEMENT(S) _____________
REAL PROPERTY AMOUNT
$ _____________
TOTAL COST
$ _____________
Explain any unusual circumstances regarding the acquisition of the property below, or attach supplemental data:
AFFIDAVIT (Pursuant to A.R.S. § 42-16052)
SUBSCRIBED AND SWORN TO BEFORE ME
I (type or print name) _______________________________ hereby affi rm
under penalty of perjury that I have reviewed the information contained in
THIS ________ DAY OF ____________________ YEAR: ________
this document and any supplemental documents attached and that it is true
and correct to the best of my knowledge. The source documents used to
compile the information are located at:
MY COMMISSION EXPIRES ON
___________________________________________________________
THE ______ DAY OF _______________________ YEAR: ________
___________________________________________________________
(SEAL)
and I agree they may be inspected by the County Assessor or the Arizona
Department of Revenue in order to verify data submitted herein.
___________________________________________________________
_______________________________________________________
SIGNATURE
NOTARY PUBLIC
DOR 82300 (Rev. 03/10)
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