1. Name and Mailing Address
2. Location of the Property
3. Land at this Location
Do You Own the Land at this Location?
If yes, is the name on your deed recorded as shown on this statement
4. Phone Number
Veterans:
Are you filing a claim for veteran's exemption?
If yes, a separate “Claim for Veterans’ Exemption” form must be filed with Assessor on or before February 15.
Description of Property
5. Supplies
6. Equipment
7. Other (describe)
8. Buildings or Leasehold Improvements: (describe additions and retirements in detail)
INSTRUCTIONS:
Line 5.
Enter the cost of your supplies.
Line 6.
List individually items acquired or disposed of since January 1 of last year. Additional sheets may be attached. The figure to be entered on line d may be computed by adding the figures for lines a and b and subtracting the figure for line c.
Line 7.
Enter the date acquired, cost, and description of any other personal property at this location. Additional sheets may be attached.
Line 8.
Describe in detail and show the cost of all additions and retirements to your buildings, or to your leasehold improvements to the buildings of your landlord during the year being reported. Do not repeat items that were included in line 6.
Total Full Value
Personal Property
Fixtures (improvements)
