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G. LISTING OF PERSONAL PROPERTY "FOR AN ACCURATE ASSESSMENT,WE MUST HAVE A COMPLETE
<br /> LISTING OF PERSONAL PROPERTY"
<br /> NOTE:Include ALL Expensed Assets With a Life of Greater Than 1 Year,Fully Depreciated Assets Still in Use,and Stored Assets
<br /> Which Have Been Subject to IRS Depreciation. In accordance with§ 39-3-119.5,C.R.S.,you are not required to complete this section
<br /> if the total actual value of your personal property per county is$7,300 or less. If you are a first-time filer or are unsure as to whether the
<br /> total actual value of your personal property per county exceeds$7,300,please contact the county assessor. Whether or not you file a
<br /> declaration schedule,the assessor may select your business for an audit.
<br /> Check here if there are no additions. (1)List Personal Pro erty ac uired during the revious year.(Attach se arate sheet(s),if needed.)
<br /> Item Complete Description Including Model or Year Check One Original installed Cost to Month&Year First
<br /> ID No. Ca aci Ac uired For Each Item You Placed into Service
<br /> New Used
<br /> ❑ New Used
<br /> ❑Check here if there are no deletions. (2)List Personal Pro a sold,traded,o nanently disposed of as of January 1.
<br /> ❑ New ❑Used
<br /> ❑ New ❑Used
<br /> (3 List Unlicensed Mobile E ui ment. Do not list mobile e ui men with SMM license lates,rental decals,or Z-tabs. Year In Use
<br /> New Used
<br /> New Liused
<br /> 4 List ALL leasehold Improvements. Attach separate sheets(s ,if needed.
<br /> Descripfion Year Acquired Your Original Installed Cost
<br /> H. DEPRECIATION SCHEDULE: If you file a form 4562 or 4562-A with the IRS,please provide a copy of your completed IRS Form
<br /> with an itemized listing of all personal property including the description and cost of each item. Note that all personal property that is expensed
<br /> should be included in your listing._In addition,attach a copy of the latest detailed Depreciation Schedule from your financial records.
<br /> r
<br /> 5is
<br /> LOANED,OR RENTED PROPERTY Declare Property Owned by Others.
<br /> e any leased,loaned,or rented machinery,equipment,furniture,signs,vending machines,etc.,at this location on January I?
<br /> No
<br /> ed yes,list the items below,showing owner's name,address,and telephone number;property description;etc. If any of the leased equipment
<br /> talized on your books and records,please check the box at the beginning of the line corresponding with the name of the Lessor. If additional
<br /> ed,attach a complete listing of all leased personal property. If you checked no,go to Section I to complete this form.
<br /> Original Term
<br /> Description Including Model/ New or Total Installed
<br /> Owner/Lessor's Name,Address,Tele.No. Serial No.or Capacity Used? Cost of Lease Cost Lease Number (From-To) Annual$Rent
<br /> I.I. Personal Property _T
<br /> ❑ []New $ $ $
<br /> ❑Used
<br /> censed
<br /> M
<br /> quipment Z-Tabbed.
<br /> ❑New $❑Used
<br /> urchase or maintenance options are included in the total annual$rent shown above,check here and furnish details.
<br /> J. DECLARATION THIS RETURN IS SUBJECT TO AUDIT
<br /> "I declare,under penalty of perjury in the second degree,that this schedule,together with any accompanying exhibits or
<br /> statements,has been examined by me and to the best of my knowledge,information, and belief sets forth a full and complete
<br /> list of all taxable personal property owned by me,or in my possession,or under my control,located in this county,Colorado,
<br /> on the assessment date of this year;that such property has been reasonably described and its value fairly represented;and
<br /> that no attempt has been made to mislead the assessor as to its age,quality,quantity,or value."§ 39-5-107(2), rC�.R.S.
<br /> PROPERTY OWNER'S FEDERAL EMPLOYER IDENTIFICATION NUMBER(FEIN)/SOCIAL SECURITY NUMBER(SSN) 5v2�"-i 1-H 1 3-5
<br /> .f
<br /> NAME OF OWNER ? 0 Ct 6 � 61'`1 i1 E S
<br /> PRINT NAME OF PERSON SIGNING I c?c�� D ���t��I1 cS PHONE NUMBERC�70' tl�i-t1.3
<br /> E-MAIL ADDRESS �lt�l1 CSC�c C�c v'<-men ' (PSi�Cc t1 Y FAX NUMBER �l�0'�tfO " 2S 6y
<br /> SIGNATURE OF OWNER OR AGENT
<br /> DATE
<br /> ❑ Check here if new agent. If new agent,submit a letter o authorization when filing this form.
<br /> PLEASE COMPLETE SIGN AND RETURN TO THE ASSESSOR ON OR BEFORE APRIL 15 2016.
<br /> MAKE A COPY FOR YOUR RECORDS.
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