Form Boe-566-J (Front) Rp-978 - Oil, Gas, And Geothermal Personal Property Statement

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COUNTY OF LOS ANGELES • OFFICE OF THE ASSESSOR
500 WEST TEMPLE STREET • LOS ANGELES, CA 90012-2770
Telephone: 213.893.0732 • Email: assessor@co.la.ca.us • Website:
Si desea ayuda en Español, llame al número 213.974.3211
RICK AUERBACH
ASSESSOR
20
This statement is not a public document. The
OFFICIAL REqUIREMENT
information contained herein will be held secret by the
OIL, GAS, AND GEOTHERMAL
A report submitted on this form is required of you
Assessor (Code section 451); it can be disclosed only
by section 441(d) of the Revenue and Taxation Code
PERSONAL PROPERTY STATEMENT
to the district attorney, grand jury, and other agencies
(Code). The statement must be completed according
specified in Code section 408. Attached schedules are
to the instructions and filed with the Assessor on or
considered to be part of the statement.
April 1
before ________. Failure to file it on time will compel the
2. LOCATION OF THE PROPERTY:
Assessor’s Office to estimate the value of your property
from other information in its possession and add a penalty
(a separate report must be filed for each property)
of 10 percent as required by Code section 463.
Field name
CAREFULLY READ AND FOLLOW THE
ACCOMPANYING INSTRUCTIONS
1. nAme AnD mAIlInG ADDreSS
Lease name and pool
3. PARCEL NUMBER
Tax rate area
(
)
4. PHONE NUMBER
E-Mail Address (optional)
(Make necessary corrections to printed name and mailing address.)
ASSESSOR’S USE ONLY
PERSONAL PROPERTY
FULL VALUE
5. Supplies (fuel) Type:
Gravity:
Barrels:
Items
ACqUIS.
ORIGINAL
YEAR
COST
6. Office furniture
7. Warehouse stock (parts, tools, equipment, etc.)
8. Yard stock (rods, tubing, casing, etc.)
9. Other (chemicals, unlicensed vehicles, etc.)
10. DECLARATION OF PROPERTY BELONGING TO OTHERS (if none write “none”)
(SPECIFY TYPE BY CODE NUMBER)
Report conditional sales contracts in lines 6-9 as applicable
Year
Year
Description
Cost to
Annual
1. Leased Equipment
4. Vending Equipment
of
of
and Lease or
Purchase
Rent
2. Leased-Purchase Option Equipment
5. Other businesses
Acq.
Mfr.
Identification
New
Number
3. Capitalized Leased Equipment
6. Government-Owned Property
Tax Obligation:
A. Lessor B. Lessee
Lessor’s Name
Mailing Address
Lessor’s Name
Mailing Address
11. Remarks
TOTAL FULL
VALUE
DECLARATION BY ASSESSEE
Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.
I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, including accompanying schedules, statements or other attach-
ments, and to the best of my knowledge and belief it is true, correct, and complete and includes all property required to be reported 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, 20 ____.
SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT*
DATE
OWNERSHIP
TYPE (✓)
NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed)
TITLE
Proprietorship
Partnership
NAME OF LEGAL ENTITY (other than DBA) (typed or printed)
FEDERAL EMPLOYER ID NUMBER
Corporation
Telephone number
PREPARER’S NAME AND ADDRESS (typed or printed)
TITLE
Other
( )
BOE-566-J (FRONT) REV. 5 (8-04) RP-978 (Rev. 08/05)
* Agent: See back for Declaration by Assessee instructions.
THIS REPORT SUBJECT TO AUDIT

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