Form 801b - Assessor Notification Property Claimed For More Than 12 Years - 2014 Page 2
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1
22014
ASSESSOR NOTIFICATION
Form 801B
PROPERTY CLAIMED FOR MORE THAN 12 YEARS
(page 2)
A.
B.
C.*
D.
E.
F.
Property Description
State of Origin
Number
Original
Original
Assessed Value
Category
(if acquired
of Years
Assessment
Cost
(To be completed by
used)
Claimed
Year
local tax assessor.)
19. Machinery & Equipment ............
_______
16
________
_____________
__________
20. Furniture ....................................
_______
16
________
_____________
__________
21. Other .........................................
_______
16
________
_____________
__________
22. TOTALS (for columns E & F, add lines 19, 20 and 21) ...............................
_____________
__________
.60
23. Value Limitation .............................................................................................................................
__________
24. Allowable Assessed Value (in column F, multiply line 22 by line 23) .............................................
__________
25. Machinery & Equipment .............
_______
17
_______
_____________
__________
26. Furniture ....................................
_______
17
_______
_____________
__________
27. Other .........................................
_______
17
_______
_____________
__________
28. TOTALS (for columns E & F, add lines 25, 26 and 27) ..................................... _____________
__________
.55
29. Value Limitation .............................................................................................................................
__________
30. Allowable Assessed Value (in column F, multiply line 28 by line 29) .............................................
__________
31. Machinery & Equipment ............
_______
18
________
_____________
__________
32. Furniture ....................................
_______
18
________
_____________
__________
33. Other .........................................
_______
18
________
_____________
__________
34. TOTALS (for columns E & F, add lines 31, 32 and 33) ...............................
_____________
__________
.50
35. Value Limitation .............................................................................................................................
__________
36. Allowable Assessed Value (in column F, multiply line 34 by line 35) .............................................
__________
37. Total Allowable Assessed Value (in column F, add lines 6, 12,18, 24, 30 and 36) ........................
$ __________
SECTION 3. Property Tax Information (To be completed by local tax assessor.)
Property Tax Rate ___________________ Assessed Tax $ _____________________ For Taxes Assessed April 1, ___________
Assessor Signature ________________________________ Municipality Name _______________________ Date ___________
_________________________________________
______________________________________
________________
Taxpayer (or agent) Signature
Social Security Number or Federal EIN (see note, page 5)
Date
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