Annual Return To Coventry Form - Ri Tax Assessor - 2016 Page 4

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SECTION 10 LEASEHOLD IMPROVEMENTS
Fixtures, etc. owned by you and attached to, or used, in real estate owned by others and not reported elsewhere.
Leasehold improvements include, but are not limited to, wall paneling, carpeting, tile on wall and floors, ceilings,
electrical and plumbing fixtures, partitions, building additions and the like.
Calendar Year
Description of
Improvement
Depreciation
Claimed
Assessor’s
Purchased
Improvement
Cost
Rate
Full Value
Use Only
2015
5%
2014
10%
2013
20%
2012
30%
2011
40%
2010
50%
2009
60%
2008 & Prior
70%
TOTALS
SECTION 11 SIGN YOUR RETURN AND NOTARIZE
I do hereby certify and declare that, to the best of my knowledge and belief, the foregoing is a true and complete list of
all real estate and personal property owned by said Corporation, Co-Partnership or Individual in or ratable in said
Town/City on the said thirty-first day of December, 2015 at 12 o’clock midnight, Eastern Standard time; that the value
placed against each item thereof is the full and fair-cash value thereof at said time.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and
statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer
(other than officer) is based on all information of which preparer has any knowledge.
Please
Sign
Here
Signature
Date
Title
On _______________________, _________________________ personally appeared before me and made oath that the
foregoing account, by him/her signed and exhibited, contains to the best of his/her knowledge and belief, a true and full
account and valuation of all the ratable estate owned or possessed by said corporation, co-partnership, or individual.
Signature of Notary Public and Date
My Commission Expires: __________________

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