Form 22.15 - Confidential - Business Personal Property Rendition Form (Texas) - 2009

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CONFIDENTIAL - BUSINESS PERSONAL PROPERTY RENDITION

Return to:

Harris County Appraisal District

Business & Industrial Property Div.

JANUARY 1, 2009

PO Box 922007

Houston TX 77292-2007

Form 22.15 (12/08)

For assistance with this form please refer to instructions 22-15-P-INS at for assistance with this form

Business Description

Business Owner

Account Number

Business Name

iFile Number

Mail Address

Property Address

Mail Address

Agent's Name

City / State Zip

Agent Number

Part 1. Ownership Information: Please check all that apply, and correct any of the above information as necessary.

Business Closed: Date

Business Moved: New location

Date

Optional Owner Information:

New Phone No.

Mail Address

Business Sold:

Date

New Owner

Mail Address

Business Name

City/State/Zip

Type of Ownership:

Individual or Sole Proprietor

Partnership

Corporation

Other

Society

Leased Space

Area Occupied at this location (sqft)____________

Owned Space

Sales Tax Permit No.________________ Issue Date:

Part 2. Affirmation of Prior Year Rendition: Check only if applicable and your personal property assets on January 1, were exactly the same as

those assets contained in the most recent rendition statement filed.

I affirm that the information contained in the most recent rendition statement filed by the property owner in a prior tax year is accurate with respect to the

current tax year in accordance with Section 22.01(I) of the Texas Property Tax Code. [If checked, you may skip to "Signature and Affirmation"]

Part 3. Description of Assets: A description of assets is required unless you checked Part 2 of this form. Below, please check all that apply.

Inventory

Computers

Location (if different from above)___________________________________

Raw Materials

Furniture & Fixtures

Supplies

Machinery & Equipment

Work in Process

Miscellaneous

Describe Miscellaneous Assets ___________________________________

Part 4. Market Value: What do you estimate to be the total market value of your business assets?

[Page 2 is optional]

Under $20,000

$20,000 and over

[You must complete all of Page 2. Original Cost (Historical Cost) and year acquired can be provided in lieu of a Good Faith Estimate of Value.]

Complete the signature block below and return the form to the address shown above. Unless you receive an extension (see instructions), your form must be delivered or postmarked no later than April 15, 2009.

Signature and Affirmation:

Information contained in this rendition and all attachments, if any, is accurate and complete to the best of my knowledge and belief.

Notary Statement: Complete if signer is not an owner,

Owner/Agent Signature

Title

employee, or officer of the company or affiliated company

SUBSCRIBED AND SWORN TO BEFORE ME this the

Printed Name

Date

SEAL

Company Name

Phone No.

day of

, 20

Section 22.26 of the Property Tax Code states: (a) Each rendition statement or property report required or authorized by this

Notary Public, State of Texas

chapter must be signed by an individual who is required to file the statement or report. (b) When a corporation is required to file

a statement or report, an officer of the corporation or an employee or agent who has been designated in writing by the board of

directors or by an authorized officer to sign in behalf of the corporation must sign the statement or report.

If you make a false statement on this form, you could be found guilty of a Class A misdemeanor or a state jail felony under Section 37.10, Penal Code.

If you fail to timely file a rendition or property report required by Texas law, the chief appraiser must impose a penalty in an amount equal to 10 percent of the total taxes due on the property for the current year. If

the court determines that you filed a false rendition or report with the intent to commit fraud, or to evade the tax, or you alter, destroy, or conceal any record, document, or thing or present to the chief appraiser

any altered or fraudulent record, document, or thing, or otherwise engage in fraudulent conduct for the purpose of affecting the outcome of an inspection, investigation determination, or other proceeding before

the appraisal district, the chief appraiser must impose an additional penalty equal to 50 percent of the total taxes due on the property for the current year.