15 DPT-AS Form
DO NOT USE – FOR ASSESSOR ONLY
State of Colorado
DS 058 08-15
RENEWABLE ENERGY PROPERTY
DECLARATION SCHEDULE
RECEIVED
(CONFIDENTIAL DATA)
COMPLETED
NO
LATE FILING PENALTY APPLIED
YES
RETURN TO COUNTY ASSESSOR
________________ County
SCHEDULE/ACCT.
B.A. CODE
T.A. CODE
Assessment Date
Due Date
NO.
January 1, 2015
April 15, 2015
PHYSICAL LOCATION/ADDRESS OF THE RENEWABLE
A. NAME AND MAILING ADDRESS
(INDICATE ANY CHANGES OR CORRECTIONS)
ENERGY PROPERTY AS OF JANUARY 1, 2015
CHECK HERE IF THERE ARE NO CHANGES FROM LAST YEAR’S DECLARATION SCHEDULE INFORMATION.
IF SO, GO DIRECTLY TO SECTION C. COMPLETE THE FORM, SIGN IT, AND RETURN FORM TO THE ASSESSOR.
B
ELECTRICAL GENERATION INFORMATION:
.
IS THIS RENEWABLE ENERGY SYSTEM A STATUTORILY DEFINED COMMUNITY SOLAR GARDEN UNDER §40-2-
127(2)(b)(I)(A), C.R.S.? Yes No
IF YES, HOW MANY TOTAL SUBSCRIBERS DOES THE COMMUNITY SOLAR GARDEN HAVE? ______________________
WHAT PERCENTAGE OF THE ELECTRICITY GENERATION CAPACITY (IN AC) IS ATTRIBUTABLE TO GOVERNMENTAL,
RESIDENTIAL, OR PROPERTY TAX EXEMPT SUBSCRIBERS? ______________________________ %
TOTAL NUMBER OF SEPARATE RENEWABLE ENERGY PROPERTIES OWNED IN THIS COUNTY: __________
(IF MORE THAN ONE, A SEPARATE DS-058 MUST BE COMPLETED FOR EACH PROPERTY)
Electric Generation Capacity
Date First Used to
Complete System Description
Property Location and Address
Generate Energy
(As declared in or converted to kW in AC)
Attach to this form a copy / copies of any Solar Purchase Power / Net Metering Agreement(s), along with any Amendment(s).
C. DECLARATION
THIS RETURN IS SUBJECT TO AUDIT
“I declare, under penalty of perjury in the second degree, that this schedule, together with any accompanying exhibits or statements, has been
examined by me and to the best of my knowledge, information, and belief sets forth a full and complete list of all taxable personal property owned by
me, or in my possession, or under my control, located in this county, Colorado, on the assessment date of this year; that such property has been
reasonably described and its value fairly represented; and that no attempt has been made to mislead the assessor as to its age, quality, quantity, or
value.” § 39-5-107(2), C.R.S.
PROPERTY OWNER’S FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)/SOCIAL SECURITY NUMBER (SSN) ________________________
NAME OF OWNER ___________________________________________________________________________________________
PRINT NAME OF PERSON SIGNING ____________________________________PHONE NUMBER _______________________
E-MAIL ADDRESS ___________________________________________________FAX NUMBER ___________________________
SIGNATURE OF OWNER OR AGENT ___________________________________________DATE __________________________
Check here if new agent. If new agent, submit a letter of authorization when filing this form.
PLEASE COMPLETE, SIGN AND RETURN TO THE ASSESSOR ON OR BEFORE APRIL 15, 2015.
MAKE A COPY FOR YOUR RECORDS.
A SEPARATE DS-058 IS REQUIRED FOR EACH RENEWABLE ENERGY SYSTEM