Form 571-L - Business Property Statement - Los Angeles County Assessor

BUSINESS PROPERTY STATEMENT

571-L

2005

COUNTY OF LOS ANGELES

Email:

assessor@co.la.ca.us

Website:

RICK AUERBACH, ASSESSOR

( Declaration of costs and other related property information as of 12:01 A.M., January 1, 2005)

Si desea ayuda en Espanol, llame al numero (213) 974-3211.

FILE RETURN BY APRIL 1, 2005

COMPANY NUMBER

ROUTING

SITUS

ACCT. FORM

AUDIT

P.C.

B.C.C.

ASSEMBLE WITH

ASSESSOR’S USE ONLY

RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED.

(Make necessary corrections to the printed name and mailing address.)

ASSESSOR’S USE ONLY

TAX RATE

ASSESSOR’S IDENTIFICATION NUMBER

Form size is 8.5" x 14"

AREA

MAP BOOK

PAGE

PARCEL

LOCATION OF PROPERTY

(File a separate statement for each location.)

GENERAL INFORMATION

COMPLETE (a) THRU (g)

ASSESSOR’S

PART I:

g. During the period of January 1, 2004 through December 31, 2004:

USE ONLY

a. Enter type of business:

(1) Has all or part of this real property been subject to a change in

ownership?

YES

b. Enter local telephone number (

)

FAX number (

)

RETAIN

(2) Are any related entities conducting business in the county?

E-Mail Address

(optional)

YES

TREND

c. Do you own the land at this business location?

YES

If yes, provide name, mailing address, and locations:

If yes, is the name on your deed recorded

OVERRIDE

YES

as shown on this statement?

KILL BILL

d. When did you start business at this location?

(3) If you leased this real property, has it been the subject of a lease

DATE:

If your business name or location has changed from last year,

agreement for a period of 35 years or more (including options)?

enter the former name and/or location:

YES

(4) Did you acquire “control” through acquisition of stock or otherwise

INACTIVE

Enter location of general ledger and all related accounting records

of a legal entity which owns real property in this county?

(include zip code):

YES

DELETE

(5) Did another person or entity acquire “control” through acquistition of

Enter name and telephone number of authorized person to contact

stock or otherwise of this corporation or entity?

at location of accounting records:

A/C

YES

DECLARATION OF PROPERTY BELONGING TO YOU

PART II:

ASSESSOR’S USE ONLY

LEGEND

COST

(attach schedule for any adjustment to cost)

(omit cents)

FULL CASH VALUE

(see instructions)

BILL#

1. Supplies

(From line 38)

2. Equipment

TOTAL F.C.V.

(Attach Schedule)

3. Equipment out on lease, rent, or conditional sale to others

(From line 63)

4. Bldgs., Bldg. Impr., and/or Leasehold Impr., Land Impr., Land

(Attach Schedule)

5. Construction in Progress

FOR

(See instructions)

6. Alternate Schedule A

LESS FIXTURES

ESCAPE ASSM’T

PERSONAL PROP.

TYPE

CODE

PART III:

DECLARATION OF PROPERTY BELONGING TO OTHERS - IF NONE WRITE “NONE”

ADD

(SPECIFY TYPE BY CODE NUMBER)

INTEREST

Report conditional sales contracts that are not leases on Schedule A

Description

Year

Cost to

Annual

and Lease or

Purchase

Rent

1. Leased equipment

4. Vending equipment

AFTER

Identification

New

Acq.

Mfr.

2. Lease-purchase option equipment

5. Other businesses

3. Capitalized leased equipment

Number

6. Government-owned property

APPLY 10% PEN

Tax Obligation: A. Lessor B. Lessee

9. Lessor’s name

Mailing address

10. Lessor’s name

Mailing address

DEPUTY

DECLARATION BY ASSESSEE

OWNERSHIP TYPE ( )

Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.

Proprietorship

I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, including accompanying schedules,

DATE

statements or other attachments, and to the best of my knowledge and belief it is true, correct, and complete and includes all property required to be reported

Partnership

which is owned, claimed, possessed, controlled, or managed by the person named as the assessee in this statement at 12:01 a.m. on January 1, 2005.

Corporation

SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT*

DATE

APPROVAL

Other

_____________

(typed or printed)

NAME OF ASSESSEE OR AUTHORIZED AGENT*

TITLE

BUSINESS