Form Boe-517-Wt (S1f) - Declaration Of Costs And Other Related Property Information As Of 12:01 A.m., January 1, 2005 - California Board Of Equalization

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BOE-517-WT (S1F) REV. 9 (12-04)
STATE OF CALIFORNIA
PROPERTY STATEMENT — WIRELESS TELEPHONE
BOARD OF EQUALIZATION
2005
DECLARATION OF COSTS AND OTHER RELATED PROPERTY INFORMATION
AS OF 12:01 A.M., JANUARY 1, 2005
This statement must be completed, signed, and filed with the Valuation Division, Board of Equalization, P.O. Box 942879,
Sacramento, California 94279-0061, by March 1, 2005. Omit cents; round to the nearest dollar.
OFFICIAL REQUEST
NAME, STREET, CITY, STATE, and ZIP CODE
This request is made in accordance with section 826 of the Revenue
and Taxation Code. This property statement must be completed
according to the instructions and filed with the Board of Equalization
on or before March 1, 2005. If you do not file this statement, you may
be subject to the penalty provided in section 830 of the Revenue and
Taxation Code. Attached schedules are considered to be part of the
statement. THIS STATEMENT IS SUBJECT TO AUDIT.
SBE NO.
MAKE NECESSARY CORRECTIONS TO ADDRESS LABEL
Name and address of person to whom correspondence
DATE
DATE TO BE
N/A
regarding audit should be addressed:
SUBMITTED
SUBMITTED
THIS STATEMENT SHALL CONSIST OF:
NAME
(1) Tangible Property List (BOE-532, -533, et al.)
(2) Statement of Land Changes
MAILING ADDRESS (including zip code)
(3) Financial Schedules A to E
(4) Schedule of Wireless Communications Sites
TELEPHONE NUMBER
(5) Schedule of Intangible Information
(
)
(6) Schedules of Leased Equipment
BOE-600-A
BOE-600-B
Location of accounting records (street, city, state and zip code) :
(7) Other Information as Requested
( see instructions on reverse)
a. Payments to Local Governments
E-MAIL ADDRESS
b. Stmt. of Rev/Cost Changes
c.
Annual Rept. to Federal Agencies
NAME OF AUTHORIZED REPRESENTATIVE (if applicable) *
d. Annual Rept. to State Agencies
e. Form 10K
ADDRESS (street, city, state, zip code)
f.
Shareholders Report — 3 copies
g. Working Cash Statement
DAYTIME TELEPHONE NUMBER
h. Inventory Data
(
)
i.
Other
* Statement of Authorization (BOE-892) must be filed annually.
List primary business activities generating revenue:
(✔) ENTITY TYPE:
Proprietorship
Partnership
Corporation
Other
Change in ownership prior 12 months?
Yes
No
CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California that I have examined this Property Statement, including accompanying schedules
and statements, and to the best of my knowledge and belief it is true, correct, and complete and covers all property required to be reported which is owned, claimed,
possessed, controlled, or managed by the person named in the statement at 12:01 a.m. on January 1, 2005. If prepared by a person other than the taxpayer, this
declaration is based on all information of which preparer has knowledge.
FOR OFFICIAL USE ONLY
FULL LEGAL NAME IF INCORPORATED
SIGNATURE OF OWNER, PARTNER, OFFICER, OR AUTHORIZED AGENT
DATE
2005
PRINTED NAME OF SIGNATORY
TITLE
SIGNATURE AND ADDRESS OF PREPARER OTHER THAN TAXPAYER
DATE
2005
CONTINUED

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