Tangible Personal Property Tax Return
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1
2ACCOUNT#:
STATE OF FLORIDA
TANGIBLE PERSONAL PROPERTY TAX RETURN
LOCATION #:
COUNTY OF
Confidential § 193.074 F.S.
POLK
RP PARCEL #:
As Required by §§ 193.052 & 193.062 F.S.,
Return To County Property Appraiser
MILL CODE:
2016
By April 1 To Avoid Penalties
ZONE:
FEDERAL EMPLOYER IDENTIFICATION NUMBER
SOCIAL SECURITY NUMBER
NAICS
For instructions see:
-
-
-
BUSINESS NAME (DBA) AND MAILING ADDRESS:
MAIL COMPLETED RETURN TO:
MARSHA M. FAUX, CFA, ASA
POLK COUNTY PROPERTY APPRAISER
255 N. WILSON AVENUE
BARTOW, FL 33830
PHONE NUMBER: (863)534-4777
THIS RETURN IS SUBJECT TO AUDIT WITH ALL RECORDS KEPT BY YOU, IMCOMPLETE ENTRIES ARE SUBJECT TO PENALTIES
If name or address is incorrect, please make necessary corrections
1. Please Give Name and Telephone Number of Owner or Person in Charge.
5. Date You Began Business In This County: _______________ Fiscal Year: ________________
5a. Although my fiscal year ended prior to December 31 of the past calendar year, this return
Name:___________________________________________________________
reflects property additions and deletions through Dec. 31. Yes ____ No ____
Tel. #: ___________________________ Fax: ___________________________
6. Describe Type or Nature of Your Business ________________________________________
Email Address: ____________________________________________________
____________________________________________________________________________
Corp Name/DBA: __________________________________________________
7. Trade level: (Circle as many that apply) Retail
Wholesale
Manufacturing
2. Actual Physical Location of This Property (Street Address – NOT PO BOX):
Professional
Service
Agriculture
Leasing/Rental
Other
________________________________________________________________
8. Did You File a Tangible Personal Property Return in This County Last Year?
3. Is Your Business or Farm Located Within the Incorporated Limits of a City?
Yes ____ No ____ If Yes, Under what Name and Address? ______________________________
Yes ____ No ____ If Yes, what City? ___________________________________
_____________________________________________________________________________
4. Do You File a Tangible Personal Property Tax Return Under any Other Name?
9. Former Owner of the Business: _________________________________________________
Yes ____ No ____ If Yes, Please Show Name Exactly as it Appeared on your Most
9a. If Business Sold, To whom? ___________________________________________________
Recent Personal Property Tax Bill or Current Return ______________________
_________________________________________________________ Date _______________
________________________________________________________________
SCHEDULE #1
LEASED, LOANED, AND RENTED EQUIPMENT (PLEASE COMPLETE IF YOU HOLD EQUIPMENT BELONGING TO OTHERS.)
YEAR
YEAR
RENT PER
RETAIL INSTALLED
NAME AND ADDRESS OF OWNER LESSOR
DESCRIPTION
ACQUIRED
OF MFG.
MONTH
COST NEW
SCHEDULE #2
EQUIPMENT OWNED BY YOU BUT RENTED, LEASED, OR HELD BY OTHERS
TAXPAYER’S
ESTIMATE OF
CONDITION
FAIR
(GOOD)
RETAIL
LEASE
NAME/ADDRESS OR LESSEE
YEAR
MARKET
(AVG.)
INSTALLED
RENT PER
NO
ACTUAL PHYSICAL LOCATION
DESCRIPTION
AGE
PURCHASED
MONTH
TERM
VALUE
(POOR)
COST NEW
TAXABLE VALUE
LESS EXEMPTION: [ ] WIDOW
[ ] TOTAL DISABILITY
[ ] WIDOWER
[ ] BLIND
[ ] OTHER
DEPUTY
PENALTY
Under penalties of perjury, I declare that I have read the foregoing tax return and that the facts stated in it are true. If prepared by someone other than the taxpayer, the preparer signing this return certifies that
his/her declaration is based on all information of which he/she has any knowledge.
DATE: _____________ TITLE: _____________________________________
PRINT: _______________________________________________________
(PRINT TAXPAYER NAME)
SIGNED: _______________________________________________________
PRINT: _______________________________________________________
(TAXPAYER SIGNATURE – REQUIRED)
(PRINT PREPARER NAME)
SIGNED: _______________________________________________________
CITY, STATE, ZIP: ______________________________________________
(PREPARER SIGNATURE – REQUIRED)
PREPARER’S ID: _______________________________________________
ADDRESS: _____________________________________________________
PHONE NO.: ___________________________________________________
PLEASE SIGN AND DATE YOUR RETURN. SEND THE ORIGINAL TO THE COUNTY
NOTICE: IF YOU ARE ENTITLED TO A WIDOW’S, WIDOWER’S, OR
ST
APPRAISER’S OFFICE BY APRIL 1
. UNSIGNED RETURNS CANNOT BE ACCEPTED BY
DISABILITY EXEMPTION ON PERSONAL PROPERTY (NOT ALREADY
THE APPRAISER’S OFFICE
CLAIMED ON REAL ESTATE), PLEASE CONSULT THE APPRAISER.
ALL INFORMATION ON BOTH SIDES MUST BE COMPLETED IN FULL TO BE A VALID RETURN
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