2004 Personal Property Declaration Page 5
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1
2
3
4
5
6List or Account #:
Assessment date October 1, 2004
Required return date November 1, 2004
Owner’s Name:
DBA:
SECTION E - D
, S
T
P
R
& R
F
A
ISPOSAL
ALE OR
RANSFER OF
ROPERTY
EPORT
ECONCILIATION OF
IXED
SSETS
Disposal, sale or transfer of property – If you disposed of, sold, or transferred a portion of the property included in last year’s filing,
complete R
F
A
and the D
L
D
A
R
. If you no longer own the business noted on
ECONCILIATION OF
IXED
SSETS
ETAILED
ISTING OF
ISPOSED
SSETS
EPORT
the cover sheet you do not need to complete this declaration. You must, however, return to the Assessor this declaration along with the
complete A
B
C
S
B
Found on page 6 of this return.
FFIDAVIT OF
USINESS
LOSING OR
ALE OF
USINESS
Assets declared 10/1/03
Assets added since 10/1/03
Assets declared 10/1/04
-
Assets disposed of since 10/1/03
*
+
=
-
+
=
Expensed equipment last year
*
Complete– D
L
D
A
R
See below
ETAILED
ISTING OF
ISPOSED
SSETS
EPORT
D
L
D
A
R
ETAILED
ISTING OF
ISPOSED
SSETS
EPORT
COPY AND ATTACH ADDITIONAL SHEETS IF NEEDED
Date Removed
Description of Item
Date Acquired
Acquisition Cost
SECTION G - Exemption and Affidavit-
Check box adjacent to the exemption you are claiming:
Cod
Exemption Amt.
e
Mechanic’s Tools - $500 value
Horses/ponies $1000 assessment per animal
Water Pollution or Air Pollution control equipment - Connecticut DEP certificate required -
provide copy
Distressed Municipality/Enterprise Zone - Exemption application
M-55 required annually
New manufacturing machinery and equipment claimed under Code #13 - Exemption
application M-65 required annually
Page 5
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