Arizona Renter's Certificate of Property Taxes Paid

Renter's Certificate of Property Taxes Paid
Arizona Form 201
Arizona Form

201

2023

Renter’s Certificate of Property Taxes Paid

Use Form 201 if you rented in 2023 and are claiming the property tax credit. This certificate
shows what portion of your rent money went to pay taxes. Your landlord or designated agent must
sign and complete this form in order for you to qualify for your credit. USE BLACK INK ONLY.

HOW TO USE THIS FORM

Homeowners:
If you own the home you live in, do not use this form.
Homeowners claiming a property tax credit rebate must send a
statement of property taxes paid rather than this form.
See Form 140PTC instructions.

Renters Seeking a Tax Rebate on Form 140PTC:
1.	 Ask your landlord to complete Part 2 of this form.
2.	 Complete Parts 1 and 3 if you qualify. See instructions.
3.	 Use this information to complete your Form 140PTC.
4.	 Include this certificate with your Form 140PTC and keep
a copy for your tax records.

IMPORTANT:	 For 2023, be sure to have your landlord complete this form well before April 15, 2024 or request an extension (Arizona
Form 204) to protect the credit. Landlords may not have the information immediately available. The extension will give
you until October 15, 2024 to file Form 140PTC and Form 201.

Part 1

To be Completed by Tenant

First Name and Initial - also give spouse’s name and initial

Part 2
	1
	2
	3
	4
	5

Last Name

Social Security Number

To be Completed by Your Landlord

Name of Landlord

Number and Street Address
City

County

State

ZIP Code

County

State

ZIP Code

Business Name of Rental Property (if applicable)
Number and Street Address
City

	6
	7 If any of your tenants received rent subsidies in 2023, check this box.................................................	 7	

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	8 If the property was exempt from property tax during 2023, check this box...........................................	 8	
If you checked box 8, tenants may not claim the property tax credit on any form or schedule.

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	9 If you occupy any portion of the property you rent or lease to others, check this box...........................	 9	

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	10 Enter property tax factor........................................................................................................................ 10

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Signature of Responsible Party:

I declare that I have examined this statement and to the best of my knowledge and belief, it is correct and complete.
	

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Part 3

	
	
	

SIGNATURE OF OWNER, LESSOR, OR MANAGER OF RENTAL PROPERTY	

DATE

PRINT OR TYPE NAME OF SIGNING PARTY		
OWNER’S OR PROPERTY MANAGER’S PHONE NUMBER
		
(for verification of information only)

Tenant Claiming Property Tax Credit Must Complete Part 3

13 Enter total rents paid in 2023 not including subsidies.......................................................................... 	13
14 Enter property tax factor from Part 2, line 10....................................................................................... 	14
15 Multiply line 13 by line 14. Enter the result here and on Form 140PTC, line 13. This is the
amount of rent which constitutes property taxes................................................................................. 	15

ADOR 10417 (23)

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