2010-09-17_REPORT - M2005032

• Permit No: M2005032
• IBM Index Class Name: REPORT
• Doc Date: 9/17/2010
• Doc Name: Annual Fee/Report/Map
• From: Sprague Scraper Service, Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: MAC
• Media Type: D
• Archive: No

Q LWnWG OF PERSONAL PROPERTY -FOR Alai ACCURATE ASSFSSMEW, Wit MUST HAVE A CONWLLTZ
LL4nM OF PERSONAL PROPERTY**
NOTE: Indnde ALL Expensed Assets With a life of Creates Tlwo I Year, Fully Depreciated Assets Still in Use, and Stored Assets
Wbidr (lave Been Subject to IRS DepfCCbdoh. In accordance with § 39-3-119.5, CR.S., you are not required to complete this section
if the total actual value of your personal property per county is $4,000 or less. If you area first-time filer or arc unsure as to wledwrthe
tow actual value ofyour personal property per county exceeds $4,000, please contact the county assessor. Whetdier or ent Pero Me •
deduradw eelreduk% the *messw say select year b doers-for as audit.
? Check here if there are no addi4ons. (1) I.At Personal hoperty ma Bred duriat tie Previous Year : (Atindh semarate aiaRsk frunded.)
Item
in No. Caapleie Description Iowkdieg Model or yew Creek Os
For Edell Item Original installed Cost to
You I1 -1 de Yaw First
Pbsxd into Serviee
? New Used
N
ZOZ3 / -
Z) 2-
0 New ? Used
? New ? used
? Chuck hem if there are no detegia m I.fst Persons{ sold. haded. or permanently- digiond ofas ofJunuary 1.
? New ? Used
? New ? Used
? New ? Used
Lbf Unllmosed Mobile SaaWmeoL Do not list mobile with SMM Imam plates rcnW or ZAabs. Yew Is the
? New ? Used
? New ? Used
? New ? Used
Lint ALL kw eioW Improvements. Auac h . s if needed.
Year
Acquired
Year IastsNeel Cott
4
IL DEPRECIATION SCHEDULE: ifyoa file a form 4562 or 4562-A with the IRS, ph= provide a dopy ofyor completed IRS Form
with an itemized listing ofall panosl property including the description and cost ofeach item. Nate doer all person property that is expensed
d oM be inducted in your ibunit. to adoitm attach a eouov of the to and de Whmd i>erat , 3dw.hAe- f a, vsww r .-.uc
L LEASED, D
Id3ANE, OR RENTED PROPERTY (FuMwee, Signs, etc.) Declare Persea d Properly Owned by Others Hem
U C he& here if yon possessed any leased, hoane dl or m tcd nad inay, exluipmem, fuunihse, sign& vending madam can bn mey i"_
Do not net mobile segnquaeert with SMM Bemse plates, r+eatai decub, her Z-labs.
List beNw, dwaieg owner's snare. address, and mlepiom number; prupeeiy daaiptioaa err. if any ofthe leased ap4mem bap'
an your books and E!eEg& please edP a the bas at the hAglauiag of the: lbw wits the Phsme of the )i.erasor.
ms's Name
A T Number Dea'iptiOn
SlodellSerLi Ne. Can of Lease Lease Naaebew Teenn
From -.To Annual S Rent

0

Ave purdwe or maintenance options inetudcd io due total-arnmal seat - a••.- -`, ? Yes ? No If yes, *M ftanidh deans.
J. DELI ARATTON
TIM RETURN 18 s7Bjwr TO At3Dfi'
"I declam; under penalty of perjury in the sex:eatd degree, ittat this sdtedutte, togedues with any ac anying exhibits or
stattmWURS, has been examined by me and to the best of ray knowledge, infa>T nkx4 and belief sets forth a lull and complete
list of ail taxable personal property owned by me, or in cry pion, or undo In c:otttol, located in thhis exnmty, Colorado,
on the assessment date of this year, that suer propaty has been nmsonW* described and its value fairly Masented; and
dolt no attempt has been made to mislead the assessor
OF OWNER QQ r' JCX U L _ I ?, . _ "1'r Cr 1? SP1,9
PRIM f NAME OF PERSON SIGNING PHONfs NUMBER E-MAIL ADDRESR. "l?Ue d oh ?mai
PAX NUMBER _
J

n when;. filing this form. -
PLEASE COMPLEI T SIGN, AND RE MVN TO TIRE ASSRSS9OR ON OR BIEOIO E APRIL IS-,2W.
M, AKB A COPY FOR YOUR k-KWRm