Revised 3/2/20
Pima County Board of Supervisors
Date: ___________________ TAX YEAR: 2020
Name and Address of Applicant:
Last Name First Name
Address City State Zip
Mailing address, if different from above:
Address City State Zip
Phone Number Email Address
Parcel/Roll Number or License: _______________________________________________________
Exemption type: _____ Personal: (select one) [ ] Disabled [ ] Widow/Widower
_____ Non-Profit Organization __________________________________________
Name of Organization
My affidavit for property tax exemption was not filed before the March 1st deadline.
This is a request that the waiver of the property tax exemption be redeemed by the Pima County
Board of Supervisors under A.R.S. §42-11153(B). NOTE: If taxes have become due, this
application will not be processed and is hereby denied in conformance with Statute A.R.S.
§42-11153(B) and Pima County Board of Supervisors Policy C4.3.
Please return this form to:
Pima County Clerk of the Board of
Supervisors 130 W. Congress St., 1
Tucson, AZ 85701
Email to:
Clerk of the Board’s Use Only
oved at the Board of Supervisor’s Meeting:
: ___________________
Clerk’s Signature: __________________________
This Approved redemption waiver should be included
with your application to the Assessor’s Office.