Form 571-R - Apartment House Property Statement - 2013
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2BOE-571-R (P1) (P2) REV. 15 (05-12) ASSR-524 (REV. 12-12)
APARTMENT HOUSE PROPERTY STATEMENT
2013
571-R
COUNTY OF LOS ANGELES • OFFICE OF THE ASSESSOR 500 W. TEMPLE ST., ROOM 208, LOS ANGELES, CA 90012-2770
Telephone: 213.974.8656 • Email: helpdesk@assessor.lacounty.gov • Website: assessor.lacounty.gov • Si desea ayuda en Español, llame al número 213.974.3211
(Declaration of costs and other related property information as of 12:01 A.M., January 1, 2013)
ROUTING
SITUS
SUB
USE
ASSESSOR’S USE ONLY
FILE RETURN BY
TAX RATE
ASSESSOR’S IDENTIFICATION NUMBER
APRIL 1, 2013.
141
INDEX
INDEX
TYPE
CODE
ACCT FORM
AREA
MAP BOOK
PAGE
PARCEL
ASSESSOR’S USE ONLY
8
RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED.
0
1
NAME AND MAILING ADDRESS
COMPANY NUMBER
(Make necessary corrections to the printed name and mailing address.)
LOCATION OF THE PROPERTY
(street, city)
(file a separate statement for each location)
(21
3)
(21
3)
Local Telephone Number
Fax Number
2. Enter the total number of units for the location listed.
163
E-Mail Address (optional)
Enter location of general ledger and all related accounting records (include zip code):
Do you live in one of the units?
Yes
No
CITY
STATE ZIP
Yes
No
STREET
If yes, enter the unit number ______________________________
Enter name and telephone number of authorized person to contact at location of accounting records:
3. During the period of January 1, 2012 through December 31, 2012:
(1) Did any individual or legal entity (corporation, partnership,
(21
3)
limited liability company, etc.) acquire a “controlling interest” (see
instructions for definition) in this business entity?
Yes
No
CAREFULLY READ AND FOLLOW THE ACCOMPANYING INSTRUCTIONS.
(2) If YES, did this business entity also own “real property” (see
instructions for definition) in California at the time of the
1.
If you no longer own this property as of January 1 of this year, show the name and mailing
acquisition?
address of the new owner:
Yes
No
Name
(3) If YES to both questions (1) and (2), filer must submit form BOE-
100-B, Statement of Change in Control and Ownership of Legal
Mailing Address
Entities, to the State Board of Equalization. See instructions for
filing requirements.
City and State
Zip Code
4.
Do any other individuals, partnerships or corporations do business or own personal property (other than household furniture and personal effects of your tenants) located on your
premises?
Yes
No
If yes, list below.
NATURE OF THE BUSINESS OR PROPERTY
NAME AND ADDRESS OF OWNER OF SUCH PROPERTY
5.
Do you hold furniture or equipment belonging to others on a loan, rental or lease basis?
Yes
No
If yes, list below.
NAME AND ADDRESS OF OWNER OF SUCH PROPERTY
QUANTITY AND DESCRIPTION
6.
ENTER BELOW the number of fully furnished, partly furnished (e.g., stoves and refrigerators, not built-in), and unfurnished units. Also complete
ASSESSOR’S
Schedule A. Do not include, either here or in Schedule A, any unit in which you live.
USE ONLY
SLP. ROOM
STUDIO
3 BEDRM.
1 BEDRM.
2 BEDRM.
LARGER
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FULLY FURNISHED
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PARTLY FURNISHED
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UNFURNISHED
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TOTALS
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0
0
0
0
0
0
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$
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7. Supplies
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Cost
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$
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8. Furniture and appliances
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Enter From Schedule A
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$
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9. Other furniture and equipment
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Enter From Schedule B
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10.
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DECLARATION BY ASSESSEE
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TOTAL FULL VALUE
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Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.
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PERSONAL PROPERTY
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FIXTURES
I declare under penalty of perjury under the laws of the State of California that I have examined this property statement,
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including accompanying schedules, statements or other attachments, and to the best of my knowledge and belief it is true,
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OTHER IMPROVEMENTS
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correct, and complete and includes all property required to be reported which is owned, claimed, possessed, controlled,
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or managed by the person named as the assessee in this statement at 12:01 a.m. on January 1, 2012.
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LAND
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SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT*
DEPUTY:
DATE
OWNERSHIP
DATE
TYPE ( )
Proprietorship
NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed)
TITLE
ASSESSOR’S ESTIMATE
APPROVED BY:
DATE
Partnership
NAME OF LEGAL ENTITY (other than DBA) (typed or printed)
FEDERAL EMPLOYER ID NUMBER
Corporation
BATCH NUMBER
TXN
PREPARER’S NAME AND ADDRESS (typed or printed)
TELEPHONE NUMBER
TITLE
Other _______
(21
3)
*Agent: See page (P2) for Declaration by Assessee instructions.
2013
THIS STATEMENT SUBJECT TO AUDIT
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