Fillable Tangible Personal Property Schedule - Shelby County

PART III - LEASED PERSONAL PROPERTY, LESSEE SECTION

ASSESSOR’S USE ONLY

Report all items leased or rented by you for the conduct of your business as of January 1, 2010. REGARDLESS OF ANY CONTRACT BETWEEN THE LESSOR AND LESSEE AS TO WHO SHALL PAY THE TAXES, LEASED PERSONAL

PROPERTY IS TO BE REPORTED BY AND ASSESSED TO THE LESSEE.

*--Report the year of acquisition if the lessor purchased the property being used.

**--Report lessor’s original cost. Report the advertised retail price if lessor’s original cost is unknown.

Jurisdictional Change:

_________________________________

Is any personal property leased or rented for use in your business/profession or for an employee to use on behalf of your business/profession?

Yes ________ or No ________

New Town Code:

_________________________________

IF YES, THIS SECTION MUST BE COMPLETED.

Depr.

Item Description, Make

* Year

Terms of Lease and

Monthly

Lease

** Cost

Name of Lessor

Address of Lessor

Group

and Model Number

Acquired

Year Lease Began

Rent

Number

Active

Assmt.

Code

Type

Schedule Filed? (Y/N)

Date:

More Info. Requested? (Y/N)

Date:

Desk Audit By:

Date:

Field Audit By:

Date:

Book Audit By:

If additional space is needed, attach a separate sheet using the same format.

Date:

PART IV - OWNED ITEMS WITH NONSTANDARD VALUES

ASSESSOR’S NOTES--NONSTANDARD VALUE

Report property on which you wish to report a value different from standard depreciated cost where such value more closely approximates

Business Code-SIC

fair market value. Report Pollution Control Equipment in this section. The Shelby County Assessor requires supportive documentation

be submitted before accepting such value.

Review Code:

Year

Depr.

Value as of

Assessor’s

Abstract Notes:

Group

Item Description

Original Cost

Made

Factor

January 1, 2010

Use Only

Other Notes:

If additional space is needed, attach

Total

separate sheet using the same format.

PART V - ALTERNATIVE REPORTING FOR SMALL ACCOUNTS

( ) SMALL ACCOUNTS CERTIFICATION (OPTIONAL)- By checking the box at the left, I certify that the total depreciated value of my property, all groups, is $1,000 or less. I understand this certification is subject

to penalties for perjury, and I may be subject to statutory penalty and cost if this certification is proven false.

PART VI - SIGNATURE

Under the penalties prescribed by law, I hereby affirm that the information contained herein, including any accompanying documents, is true, correct, and complete, to the best of my knowledge and belief.

Print Name _______________________________________________________________ Print Title ______________________________________________________________________

Signed __________________________________________________________________ Title ___________________________________________________________________________ Date _____________________________________

IF YOU NEED ANY ASSISTANCE IN COMPLETING THIS SCHEDULE, PLEASE GIVE MY STAFF A CALL AT (901) 379-7311. CHEYENNE JOHNSON, ASSESSOR