Form Boe-571-L - Business Property Statement - 2015

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BOE-571-L (P1) REV. 20 (05-14) ASSR-49 (REV. 8-14) C
571-L
BUSINESS PROPERTY STATEMENT
2015
COUNTY OF LOS ANGELES
Email: helpdesk@assessor.lacounty.gov
Website: assessor.lacounty.gov
OFFICE OF THE ASSESSOR
Si desea ayuda en Español, llame al número 213.974.3211.
S
BR
FILE RETURN BY
APRIL 1, 2015
COMPANY NUMBER
U
HM
HQ
BM
ROUTING
SITUS
ACCT. FORM
AUDIT
P.C.
B.C.C.
ASSEMBLE WITH
ASSESSOR’S USE ONLY
NAME AND MAILING ADDRESS
(Make necessary corrections to the printed name and mailing address.)
ASSESSOR’S USE ONLY
TAX RATE
ASSESSOR’S IDENTIFICATION NUMBER
AREA
MAP BOOK
PAGE
PARCEL
LOCATION OF THE BUSINESS PROPERTY
(File a separate statement for each location.)
RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED.
GENERAL INFORMATION
COMPLETE (a) THRU (g)
ASSESSOR’S
PART I:
USE ONLY
a. Enter type of business:
g. During the period of January 1, 2014 through December 31, 2014:
RETAIN
Enter local telephone number (
)
b.
FAX number (
)
Email Address
(1)
Did any individual or legal entity (corporation, partnership, limited liability
ASSESSED
c. Do you own the land at this business location?
company, etc.) acquire a “controlling interest” (see instructions for
YES
NO
FLAG
If yes, is the name on your deed recorded
definition) in this business entity?
YES
NO
YES
NO
as shown on this statement?
TREND
d. When did you start business at this location?
(2)
If YES, did this business entity also own “real property” (see instructions
DATE:
If your business name or location has changed from last year,
for definition) in California at the time of the acquisition?
OVERRIDE
enter the former name and/or location:
YES
NO
INACTIVE
Enter location of general ledger and all related accounting records
(3)
If YES to both questions (1) and (2), filer must submit form BOE-100-B,
e.
(include zip code):
Statement of Change in Control and Ownership of Legal Entities, to the
DELETE
State Board of Equalization. See instructions for filing requirements.
Enter name and telephone number of authorized person to contact
f.
at location of accounting records:
A/C
DECLARATION OF PROPERTY BELONGING TO YOU
ASSESSOR’S USE ONLY
PART II:
LEGEND
COST
(attach schedule for any adjustment to cost)
(omit cents)
J
FULL CASH VALUE
(see instructions)
BILL#
1. Supplies
L
2. Equipment
(From line 38)
0
TOTAL F.C.V.
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 63)
0
5. Construction in Progress
(Attach Schedule)
FOR
6. Alternate Schedule A
LESS FIXTURES
(See instructions)
J
7.
ESCAPE ASSM’T
8.
PERSONAL PROP.
L
TYPE
CODE
PART III:
DECLARATION OF PROPERTY BELONGING TO OTHERS - IF NONE WRITE “NONE”
ADD
INTEREST
(SPECIFY TYPE BY CODE NUMBER)
Description
Year
Year
Cost to
Annual
Report conditional sales contracts that are not leases on Schedule A
and Lease or
Purchase
of
of
Rent
1. Leased equipment
4. Vending equipment
AFTER
Identification
New
Acq.
Mfr.
2. Lease-purchase option equipment
5. Other businesses
Number
3. Capitalized leased equipment
6. Government-owned property
APPLY 10% PEN
Tax Obligation: A. Lessor B. Lessee
9. Lessor’s name
Mailing address
AE
10. Lessor’s name
Mailing address
DEPUTY
DECLARATION BY ASSESSEE
OWNERSHIP TYPE ( )
Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.
I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, including
Proprietorship
accompanying schedules, statements or other attachments, and to the best of my knowledge and belief it is true, correct, and complete
DATE
Partnership
and includes all property required to be reported which is owned, claimed, possessed, controlled, or managed by the person named as the
assessee in this statement at 12:01 a.m., January 1, 2015.
Corporation
SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT*
DATE
APPROVAL
Other
_____________
NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed)
TITLE
BUSINESS
DESCRIPTION
( )
FEDERAL EMPLOYER ID NUMBER
NAME OF LEGAL ENTITY
other than DBA) (typed or printed)
(
Retail
Wholesale
TITLE
USER
YR AE
PREPARER’S NAME AND ADDRESS (typed or printed)
TELEPHONE NUMBER
CODE
Manufacturer
(
)
Service/Professional
*Agent: see Declaration by Assessee section of instructions (back) (P6).
THIS STATEMENT SUBJECT TO AUDIT
INFORMATION PROVIDED ON A PROPERTY STATEMENT MAY BE SHARED WITH THE STATE BOARD OF EQUALIZATION

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