Form Boe-571-L - Business Property Statement - 2013

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CORRECTED
BOE-571-L (P1) REV. 18 (05-12)
BUSINESS PROPERTY STATEMENT
571-L
DECLARATION OF COSTS AND OTHER RELATED PROPERTY INFORMATION
AS OF 12:01 A.M., JANUARY 1, 2013
2013
SLUC
BUSINESS ACCOUNT NUMBER
Paul Dictos, C.P.A.
Fresno County Assessor
P. O. Box 1146 Fresno, CA 93715
ASSESSOR’S PARCEL NUMBER
SUB NUMBER
AS SESS O R ’ S U SE O N L Y
FILE RETURN BY APRIL 1, 2013
LOCATION OF THE PROPERTY
(File a separate statement for each location.)
NAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address.)
IF YOU NEED ASSISTANCE, CALL (559) 600-3534
RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED.
OR GO TO
f. Enter name and telephone no. of authorized person to contact at location of accounting
PART I: GENERAL INFORMATION
records:
COMPLETE (a) THROUGH (g)
g. During the period of January 1, 2012 through December 31, 2012:
a. Enter type of business:
(1) Did any individual or legal entity (corporation, partnership, limited liability company,
b. Enter local telephone no. (
)
FAX number (
)
etc.) acquire a “controlling interest” (see instructions for defi nition) in this business
E-mail address (optional):
entity?
c. Do you own the land at this business location?
Yes
No
Yes
No
If yes, is the name on your deed recorded
(2) If YES, did this business entity also own “real property” (see instructions for defi ni-
as shown on this statement?
Yes
No
tion) in California at the time of the acquisition?
d. When did you start business at this location? DATE:
Yes
No
If your business name or location has changed from last year, enter the former name
(3) If YES to both questions (1) and (2), fi ler must submit form BOE-100-B, Statement
and/or location:
of Change in Control and Ownership of Legal Entities, to the State Board of Equal-
e. Enter location of general ledger and all related accounting records (include zip code):
ization. See instructions for fi ling requirements.
COST
PART II: DECLARATION OF PROPERTY BELONGING TO YOU
(omit cents)
ASSESSOR’S USE ONLY
(attach schedule for any adjustment to cost)
(see instructions)
1. Supplies
2. Equipment
(From line 35)
3. Equipment out on lease, rent, or conditional sale to others
(Attach Schedule)
4. Bldgs., Bldg. Impr., and/or Leasehold Impr., Land Impr., Land
(From line 71)
5. Construction In Progress
(Attach Schedule)
6. Alternate Schedule A
(See instructions)
7.
8.
PART III: DECLARATION OF PROPERTY BELONGING TO OTHERS – IF NONE WRITE “NONE”
(SPECIFY TYPE BY CODE NUMBER)
Description
Year
Year
Cost to
Report conditional sales contracts that are not leases on Schedule A
Annual
and Lease or
of
of
Purchase
Rent
Identifi cation
1. Leased equipment
3. Capitalized leased equipment
5. Other businesses
Acq.
Mfr.
New
u
6. Government-owned property
Number
2. Lease-purchase option equipment
4. Vending equipment
Tax Obligation:
A. Lessor
B. Lessee
u
9. Lessor’s name
Mailing address
10. Lessor’s name
Mailing address
DECLARATION BY ASSESSEE
OWNERSHIP
Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.
( )
TYPE
I declare under penalty of perjury under the laws of the State of California that I have examined this
ASSESSOR’S USE ONLY
Proprietorship
property statement, including accompanying schedules, statements or other attachments, and to the
Roll Changes
Partnership
best of my knowledge and belief it is true, correct, and complete and includes all property required to
Land
A1
be reported which is owned, claimed, possessed, controlled, or managed by the person named as the
Corporation
assessee in this statement at 12:01 a.m. on January 1, 2013.
Other
Imps.
B2
SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT*
DATE
BUSINESS
( )
Fix. (TFI)
C3
DESCRIPTION
Retail
Per. Prop.
D4
NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed)
TITLE
Wholesale
Ex.
H1
A
Manufacturer
NAME OF LEGAL ENTITY (other than DBA) (typed or printed)
FEDERAL EMPLOYER ID NO.
Service/Professional
Ex.
J3
ASSESSOR’S USE ONLY
Ex.
K4
PREPARER’S NAME AND ADDRESS (typed or printed)
TELEPHONE NUMBER TITLE
Pen.
Appr.
(
)
*Agent: See page 7 for Declaration By Assessee instructions
THIS STATEMENT SUBJECT TO AUDIT
INFORMATION PROVIDED ON A PROPERTY STATEMENT MAY BE SHARED WITH THE STATE BOARD OF EQUALIZATION
*13571L*

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