Declaration Of Personal Property - Short Form - Connecticut

Commercial and financial information is not open to public inspection

Assessment date October 1, 2004

Required return date November 1, 2004

List or Account #

Owner’s Name

DBA

Address

City/State/Zip

Street location of personal property in Greenwich

Phone / Fax

Description of business:

Type of ownership:

Corporation

Partnership

LLC

Sole Proprietor

Other-Describe

Type of business:

Manufacturer

Wholesale

Service

Profession

Retail/Mercantile

Tradesman

Other

’

#9 Motor Vehicles

SSESSOR

UNREGISTERED motor vehicles (e.g. campers, RV’s, snowmobiles, trailers, trucks, passenger cars, tractors, off-road construction

vehicles, etc.) including any vehicle garaged in Connecticut but registered in another state, or any such vehicle not registered at all. If you are a farmer

NLY

eligible for the exemption under Sec. 12-91, list tractors in Code 17.

Year

Make

Model

Identification No.

Length

Weight

Purchase

Date

Value

SSESSMENTS

Code

Price

#11 Horses And Ponies

Describe your horses and ponies. A $1,000 assessment exemption per animal will be applied. If you are a farmer, the

exemption may be 100% provided Form M-28 is filed with and approved by the Assessor.

Breed

Age

Registered

Sex

Quality: Breeding/Show/Pleasure/Racing

Value

#11

#14 Mobile Manufactured Homes

if not currently assessed as real estate

Year

Make

Model

Identification No.

Length

Width

Bedrooms

Baths

Value

#14

Net Depreciated

Property Code and Description

Value

From page 2

#10 - Machinery & Equipment

Industrial manufacturing machinery and equipment (e.g., tools, dies, jigs, patterns, etc.).

#10

Include air and water pollution control equipment.

#12 - Commercial Fishing Apparatus

All fishing apparatus exclusively used by a commercial fisherman in his business (e.g.,

#12

fishing poles, nets, lobster pots, fish finders, etc.). A $500 value exemption will be applied.

#16 - Furniture & Fixtures

Furniture, fixtures and equipment of all commercial, industrial, manufacturing, mercantile, trading

and all other businesses, occupation and professions. Examples: desks, chairs, tables, file cabinets, typewriters, calculators,

copy machines, telephones (including mobile telephones), telephone answering machines, facsimile machines, postage meters,

#16

cash registers, moveable air conditioners, partitions, shelving display racks, refrigerators, freezers, kitchen equipment, etc.

#17 - Farm Machinery

Farm machinery (e.g., tractors, harrows, bush hogs, hay bines, hay rakes, balers, corn choppers,

milking machines, milk tanks, coolers, chuck wagons, dozers, back hoes, hydroponic farm equipment, aquaculture equipment,

#17

etc.), used in the operation of a farm.

#18 - Farming Tools

Farm tools, (e.g., hoses, rakes, pitch forks, shovels, hoses, brooms, etc.).

#18

#19 - Mechanics Tools

Mechanics tools (e.g., wrenches, air hammers, jacks, sockets, etc.).

#19

#20 - Electronic Data Processing Equipment

Electronic data processing equipment (e.g., computers, printers, peripheral

computer equipment, and any computer based equipment acting as a computer as defined under Section 168 of the IRS Code

#20

of 1986, etc.). Bundled software is taxable and must be included.

#23 - Average Supplies

The average monthly quantity of supplies normally consumed in the course of business (e.g.,

stationery, post-it notes, typewriter ribbons, computer disks, computer paper, pens, pencils, rulers, staplers, paper clips, medical

#23

and dental supplies and maintenance supplies, etc.).

#24 – Other

All Other Goods, Chattels and Effects Any other taxable personal property not previously mentioned or which does

not appear to fit into any of the other categories. (e.g. video tapes, vending machines, pinball games, video games, signs,

#24

billboards, coffee makers, water coolers, leasehold improvements other than realty etc.).

Total Assessment – all codes #9 through #24

Subtotal >

#25 – Penalty for failure to file as required by statute – 25% of assessment

#25

Exemption

Check box adjacent to the exemption you are claiming:

I – Mechanic’s Tools - $500 value

M – Commercial Fishing Apparatus - $500 value

I – Farming Tools - $500 value

I – Horses/ponies $1000 assessment per animal

All of the following exemptions require a separate application and/or certificate to be filed with the Assessor by November 1

J – Water Pollution or Air Pollution control equipment – Connecticut DEP certificate required – provide copy

I – Farm Machinery $100,000 value - Exemption application M-28 required annually BY OCTOBER 31

See page 4

G & H – Distressed Municipality/Enterprise Zone/Enterprise Corridor Zone - Exemption application M-55 required annually

Total Net Assessment

Assessor’s Final Assessment Total >

Page 3

’

Lessee’s Name ________________________________________

ESSEE

ISTING

EPORT

Pursuant to Connecticut General Statutes §12-

57a all leased, borrowed, consigned, loaned, rented, or stored personal property not owned by you but in your possession as of the assessment date must be included on this

form. Failure to declare, in the form and manner as herein prescribed, shall result in the presumption of ownership and subsequent tax liability plus penalties. Property you do

not lease that may be in your possession and must be reported includes (but is not limited to) dumpsters, gas/propane tanks, vending machines, water coolers, coffee machines.

Declaration Of Personal Property - Short Form - Connecticut - 2004 Page 2

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