Form L-4175d - Personal Property Statement Electric Distribution Cooperative - 2001
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1Michigan Department of Treasury, STC
This form is under authority of P.A. 206 of 1893, as amended. Filing is
633 (Rev. 12-01), Formerly L-4175D
mandatory. Failure to file is punishable by fine and/or imprisonment, as stated by
law. Any questions or comments regarding this statement should be directed to
the State Tax Commission prior to the Board of Review meeting held in March.
PERSONAL PROPERTY STATEMENT
ELECTRIC DISTRIBUTION COOPERATIVE
As of December 31, _________
Cooperative
Federal Employer ID Number (FEIN)
Area Code and Telephone Number
(
)
Address (Number and Street, P.O. Box or RR#, City, State, ZIP)
School District Code
City
Township
County
Assessing
Unit
(B)
(C)
(A)
Average Cost
Estimated Original Cost
1. Miles of Line Single-Phase
__________________________x $ ________________________ = $ _________________________
2. Miles of Line Two-Phase
__________________________x $ ________________________ = $ _________________________
3. Miles of Line Three-Phase
__________________________x $ ________________________ = $ _________________________
4. Number of Services
__________________________x $ ________________________ = $ _________________________
5. ______________________
__________________________x $ ________________________ = $ _________________________
6. ______________________
__________________________x $ ________________________ = $ _________________________
7. TOTAL (Add lines 1 thru 6)
$ _________________________
8. Percent Condition Factor (Schedule 1, Line 17, Col. I)
_________________________
9. Depreciated Average Cost (Line 7 X Line 8)
_________________________
10. Other Taxable Personal Property (See attached schedule)
_________________________
11. TOTAL (Add Lines 9 and 10)
_________________________
12. System Economic Factor
_________________________
13. True Cash Value (Line 11 X Line 12)
_________________________
14. Assessed Valuation Based on Tentative Assessment Ratio
_________________________
Did you have in your possession in this assessing unit on December 31, ___________ tangible personal property belonging
to others, including governmental units, which is not reported above?
Yes*
No
*If Yes, attach a rider showing the name and addresses of the owners and the description of the property on lease, rental, loan, etc. If you are leasing or
purchasing property under a lease purchase contract, include that property on line 10 above.
STATE OF MICHIGAN
}
COUNTY OF ______________________________________
SS
I, ___________________________________________ being duly sworn depose and say that the foregoing is a full and
true statement of all tangible personal property of the taxpayer liable to taxation in the (Township, City) of
___________________________________________________, _____________________________________________
County, Michigan on the 31st day of December, ____________.
Title
Signature
Subscribed and sworn to before me this _____________________________ day of ____________________________, __________
My Commission Expires:
Notary Public
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