PROPERTY LIST INT % ASS’D % FULL CASH
VALUE
ASSESSED
VALUE
EXEMPT
AMOUNT
LIMITED
VALUE
ASSESSED
VALUE
EXEMPT
AMOUNT
I HEREBY CERTIFY THAT I HAVE READ OVER THE FOREGOING FACTS BEFORE SUBSCRIBING MY NAME HERETO, THAT THE MATTERS
HEREIN STATED ARE ALL TRUE TO THE BEST OF MY KNOWLEDGE.
X_______________________________________________________ ___________________________________________________ _______________________
PROPERTY OWNER / AGENT EMAIL ADDRESS DATE
X_______________________________________________________ ____________________________
DEPUTY ASSESSOR DATE
DOR APPROVED FORM 82514A (Rev. 01/2020)
AFFIDAVIT FOR ORGANIZATIONAL TAX EXEMPTION
Pursuant to A.R.S. §§ 42-11101 through 42-11155
TYPE COUNTY FILE
ORGANIZATION OR BUSINESS NAME
NAME: ____________________________________________
ADDRESS: ____________________________________________
CITY: _________________ STATE ______ ZIP____________
CONTACT INFORMATION (Address if dierent than Applicant)
Name:
Address:
City: State: Zip Code:
Telephone: (Applicant Phone Number)
REMARKS:
NOTE: Signature must be notorized if not signed in the presence
of Assessors Oce Personnel.
CHECK EXEMPTION TYPE:
RELIGIOUS ORGANIZATION
CHARITABLE ORGANIZATION
CEMETERY
VETERAN’S ORGANIZATION
NON-PROFIT ORGANIZATION
LOW / MODERATE INCOME
AFFORDABLE RENTAL HOUSING
Pursuant to A.R.S. § 42-11133
EDUCATIONAL PROPERTY
Pursuant to A.R.S. § 42-11132 (B) (C)
OTHER
(SPECIFY TYPE)
Print
Clear Form
INSTRUCTIONS for completing the DOR 82514A
AFFIDAVIT for ORGANIZATIONAL TAX EXEMPTION
Pur
suant to Article IX, § 2(2) and § 2(7), of the Arizona Constitution and A.R.S. Title 42, Chapter 11, Article 3,
§§ 42-11104, 42-11105, 42-11107 through 42-11110, 42-11112 through 42-11121, 42-11124, and 42-11129
through 42-11133, and Article 4, §§ 42-11151 through 42-11155.
Read these instructions and the information on the DOR 82514A adavit
carefully before completing the form.
The Organization for which a property tax exemption affidavit is being filed, and the person completing the
affidavit who represents that Organization, are hereafter referred to singularly as the “applicant.”
Initial Year Applications:
If an initial adavit is being submitted (i.e., the applicant is ling for the rst time), and if the applicant is
exempted from federal income taxation by § 501 of the Internal Revenue Code, the County Assessor may
require the submission of a “letter of determination” issued by the I.R.S.
Note: Pursuant to A.R.S. § 42-11152, for certain categories of property tax exemptions, an Initial Year ling may be that
all is required (i.e., an annual ‘reapplication’ is not necessary). Refer to A.R.S. § 42-11153 to determine if a statutory
initial year application provision exists for the exemption being sought. If not, an annual ‘reapplication’ is required. For
those exemption categories with an Initial Year application provision, the applicant may only be required to notify the
Assessor if an event has occurred that would disqualify the applicant, or the property, from continuing to qualify for the
exemption. However, be aware that some County Assessors still do require the ling of an annual adavit in order to
monitor continued exemption eligibility.
In the “Property List” column, identify and provide a description of the real and / or personal property which
the applicant is requesting to have exempted from property taxation. Attach additional identifying or
descriptive information, if necessary. The applicant should be prepared to provide access to the listed
property for an inspection by a County Assessor’s representative, if it is requested.
Subsequent Year Applications:
Annually, correct any of the preprinted information listed on the DOR 82514A by:
Crossing out any real or personal property which the applicant no longer owns, and by adding any property
the applicant now owns that is not shown on the list.
For ALL Applicants:
Pursuant to A.R.S. § 42-11152, the County Assessor may require additional proof of the facts stated on the
adavit by the applicant before approving an exemption. A false statement that is made or sworn to in the
adavit constitutes perjury.
The Applicant or Applicant’s agent must sign the completed adavit. The adavit must be notarized if it
is not signed in the presence of an Assessor’s representative. Be sure that the copy of the adavit that is
led with the County Assessor has the applicant’s original signature on it. To assure that the property tax
exemption application is processed for the current Tax Year, if hand-delivered, le the DOR 82514A with
the County Assessor’s oce no later than the last (business) day of February. If the adavit is mailed
to the County Assessor, be sure that it is postmarked on or before the last day of February.
Note: Check with the local County Assessors Oce for their hours and days of operation if the last business
day in February of the current calendar year is a Friday. Some County Assessors Oces may now be closed
on Fridays.
The applicant should retain a copy of the signed adavit, and any attachments that are submitted with
it, as a permanent record.