Reimbursement Application

Proposition 312 Reimbursement Application

• Fields marked with * are required.

General Information

County Where Property is Located

City Where Property is Located (If property is not located within an Incorporated City, please enter NONE) Cities/towns marked with * do not impose a Primary Property Tax

Property Information (as it appears on Property Tax Statement)

Property Parcel # or Account #

Property Address Street 1

Property Address Street 2

Property Address City

Property Address Zip Code

Property Owner Information (as it appears on Property Tax Statement)

Owner Name (First and Last, or Entity/Business/Trust Name)

Owner DBA Name (if applicable)

Contact Phone Number

Contact Email Address

Check this box if you are an authorized representative filling out this application on behalf of the Property Owner. If necessary, please have the Property Owner complete a POWER OF ATTORNEY - PROPOSITION 312 form to submit with this application.

Entity Authorized Representative or POA Information

Name (First and Last and Title)

Contact Phone Number

Contact Email Address

Property Owner Mailing Address Information

Country

Mailing Address Street 1

Mailing Address Street 2

Mailing Address Street 1

Mailing Address Street 2

Mailing Address Street 1

Mailing Address Street 2

Mailing Address Street 3

Mailing Address City

Mailing Address State

Mailing Address Zip Code

Mailing Address City

Province

Postal Code

Reimbursement Request Information

1. Current Expenses for Which Reimbursement is Requested, PLUS

2. Prior Expenses from Previously-approved Applications, MINUS

3. Amounts Previously Received Based on Previously-approved Applications

4. ELIGIBLE EXPENSES

5. Enter City/Town OR County Primary Property Tax Paid in Immediately Prior Tax Year (ELIGIBLE PRIMARY PROPERTY TAXES)

6. REQUESTED REIMBURSEMENT = LESSER OF ELIGIBLE EXPENSES AND ELIGIBLE PRIMARY PROPERTY TAXES

Upload Supporting Documentation

To upload files, ensure all files are in PDF format and their combined size does not exceed 200MB. Click the Choose File button, then select one or more files from your device.

By submitting this Proposition 312 - Application for Reimbursement of Nuisance Mitigation Expenses,

I understand and agree that all information provided on all papers and documents relating to this Application may be shared with state, county, and city/town officials as necessary and without limitation for the express purposes of administering the provisions of A.R.S. § 42-17451.
I certify that I have the authority to execute this Application on behalf of myself (as the fee title holder) or on behalf of the fee title holder (either pursuant to a Power of Attorney - Proposition 312 or, if the property owner is an entity, by virtue of being an individual who is deemed to have such authority.) I understand that to knowingly prepare or present a document that is fraudulent or false is a Class 5 felony pursuant to A.R.S. § 42-1127(B)(2).
I understand that, as indicated in A.R.S. § 42-17451(J), by accepting a reimbursement approved pursuant to this Application, the Named Property Owner waives any rights under A.R.S. Tit. 12, Ch. 8, Art. 2.1 (Private Property Rights Protection Act).

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