2004 Personal Property Declaration Page 4
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6SECTION C- L
’
L
R
ESSEE
S
ISTING
EPORT
-
COPY AND ATTACH ADDITIONAL SHEETS IF NEEDED
Pursuant to Connecticut General Statutes §12-57a all leased, borrowed, consigned, loaned, rented, or stored personal property
not owned by you but in your possession as of the assessment date must be included on this form. Failure to declare, in the
form and manner as herein prescribed, shall result in the presumption of ownership and subsequent tax liability plus penalties.
Property you do not lease that may be in your possession and must be reported includes (but is not limited to) dumpsters ,
gas/propane tanks, vending machines, water coolers, coffee machines.
Yes No
Did you dispose of any leased items that were in your
possession on October 1, 2003? If yes, enter a description of
the property and the date of disposition in the space to the
right.
Did you acquire any of the leased items that were in your
possession on October 1, 2003? If yes, indicate previous
lessor, item(s) and date(s) acquired in the space to the right.
Is the cost of any of the equipment listed below declared anywhere else on this declaration? If yes, note year in the ‘Year Included’
column and list cost in the ‘Acquisition Cost’ column.
Capital
Lease
Lease
Owner’s name and address
Item Description/
Year of
Monthly
Lease
Term
Year
Number
Model No.
Serial #
Mfg.
Rent
Acquisition Cost
(Yes/No)
Beg/End
Included
SECTION D - L
’
L
R
ESSOR
S
ISTING
EPORT
-
COPY AND ATTACH ADDITIONAL SHEETS IF NEEDED
In order to avoid duplication of assessments related to leased personal property the following must be completed by Lessors: (Please note
that property under conditional sales agreements must be reported by the lessor.) Computerized filings are acceptable as long as all
information is reported in prescribed format.
Lessee #1
Lessee #2
Lessee #3
Name of Lessee
Lessee’s address
Physical location of equipment
Full equipment description
Is equipment self manufactured
Yes
No
Yes
No
Yes
No
Acquisition date
Current commercial list price new
Has this lease ever been purchased,
Yes
No
Yes
No
Yes
No
assumed or assigned?
If yes, specify from whom
Date of such purchase, etc.
If original asset cost was changed by
this transaction, give details.
Type of lease
l
Operating
Capita
Conditional
l
l
Operating
Capita
Conditional
Operating
Capita
Conditional Sale
Sale
Sale
Lease Term – Begin and end dates
Monthly contract rent
Monthly maintenance costs if included
in monthly payment above
Is equipment declared on either the
Yes
Yes
Yes
Lessor
Lessee
Lessor
Lessee
Lessor
Lessee
Lessor’s or the Lessee’s new manu-
No
No
No
facturing exemption application?
Page 4
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