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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 acquired during the previous year.(Attach separate sheet(s),if needed.)
<br /> Item Complete Description Including Model or Year Check One Original installed Cost to Month&Year First
<br /> ID No. Capacity Acquired For Each Item You Placed into Service
<br /> New LjUsed
<br /> New Used
<br /> ❑Check here if there are no deletions. (2)List Personal Property sold,traded,or permanently disposed of as of January 1.
<br /> ❑❑ New Used
<br /> ❑ New Used
<br /> 3 List Unlicensed Mobile Equipment. Do not list mobile equipment with SMM license plates,rental decals,or Z-tabs. Year In Use
<br /> New EJUsed
<br /> New Used
<br /> 4 List ALL leasehold Improvements. Attach separate sheets s ,if needed.
<br /> Year Acquired Your Ori anal Installed Cost
<br /> Description
<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 /> I.LEASED,LOANED,OR RENTED PROPERTY Declare Property Owned by Others.
<br /> Did you have any leased,loaned,or rented machinery,equipment,furniture,signs,vending machines,etc.,at this location on January 1?
<br /> ❑ Yes [[.No
<br /> If you checked yes,list the items below,showing owner's name,address,and telephone number;property description;etc. If any of the leased equipment
<br /> listed is capitalized 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 /> room is needed,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 S Rent
<br /> 1.1. Personal Property
<br /> ❑ []New $ $ $
<br /> ❑Used
<br /> I.2. Mobile Equipment Licensed
<br /> iTabb a?
<br /> ❑ ❑New $
<br /> ❑ ❑Used $ $
<br /> ❑ If purchase or maintenance options are included in the total annual$rent shown above,check here and furnish details.
<br /> J. DECLARATION THIS RETURN IS SUBJECT TO AUDIT
<br /> "I declare,under penalty of per'ury in the second degree,that this schedule,together with any accompanying exhibits or
<br /> statements,has been examined by me and to the best of my knowledge,information,and belief sets forth a full and complete
<br /> list of all taxable personal property owned by me,or in my possession,or under my control,located in this county,Colorado,
<br /> on the assessment date of this year;that such property has been reasonably described and its value fairly represented-and
<br /> that no attempt has been made to mislead the assessor as to its age,quality,quantity,or value."§ 39-5-107(p2),C.R.S.
<br /> PROPERTY OWNER'S FEDERAL EMPLOYER IDENTIFICATION NUMBER(FEIN)/SOCIAL SECURITY NUMBER(SSN) "y 135
<br /> NAME OF OWNER
<br /> PRINT NAME OF PERSON SIGNING I D I�4LLI 11 tS PHONE NUMBER 70- Q.3
<br /> E-MAIL ADDRESS h���1 CSC:�CCtIn^ <_ n k�fP$i)Ct I1 P FAX NUMBER (l 70'a)t 0
<br /> DATE
<br /> SIGNATURE OF OWNER OR AGENT
<br /> D y n II
<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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