Personal Property Declaration Form (Page 3 of 5) in pdf

Personal Property Declaration Form Page 3

Detailed Listing of Disposed Assets and Lessee's Report

List/Account #:

Assessment date October 1, 2004

Required return date November 1, 2004

Owner’s Name:

DBA: 0

Detailed Listing of Disposed Assets

Pursuant to CGS § 12-41(c) -- Listing of assets removed last year

Date Removed

Description of Item

Date Acquired

Acquisition Cost

Notes:

Reconciliation of Fixed Assets

Total Acquisition cost of:

Assets declared 10/1/03

Assets disposed of since 10/1/03

Assets added since 10/1/03

Assets declared 10/1/04

Capitalization Threshold

All leased, borrowed, consigned, loaned, rented, or stored personal property not owned by you but in your possession as of the assessment date, must be included on

this declaration. Failure to declare, in the form and manner as herein prescribed, shall result in the presumption of ownership and subsequent tax liability plus penalties.

Did you dispose of any leased items that were in your possession on

October 1, 2003? If yes, enter a description of the property and the

Yes/No

date of disposition in the space to the right.

Did you acquire any of the leased items that were in your possession

on October 1, 2003? If yes, indicate previous lessor, item(s) and

Yes/No

date(s) acquired in the space to the right.

Is the cost of any of the equipment listed below declared anywhere

else on this declaration? If yes, note year in ‘Year Included’ column

Yes/No

and list cost in ‘Acquisition Cost’ column.