Annual Return To Woonsocket Form - R.i. Tax Assessor

Annual Return To Woonsocket Form - R.i. Tax Assessor - 2016 Page 4

SECTION 11 SIGN YOUR RETURN AND NOTARIZE

I do hereby certify and declare that, to the best of my knowledge and belief, the foregoing is a true and complete list of

all real estate and personal property owned by said Corporation, Co-Partnership or Individual in or ratable in said City

on the said thirty-first day of December, 2015 at 12 o’clock midnight, Eastern Standard Time; that the value

placed against each item thereof is the full and fair cash value thereof at said time.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and

statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer

(other than officer) is based on all information of which preparer has any knowledge.

Please

Sign

Here

Signature

Date

Title

Telephone #

On _______________________, _________________________ personally appeared before me and made oath that the

foregoing account, by him/her signed and exhibited, contains to the best of his/her knowledge and belief, a true and full

account and valuation of all the ratable estate owned or possessed by said corporation, co-partnership, or individual.

Signature of Notary Public and Date

My Commission Expires: __________________

If you are no longer in business, please state the date the business

closed and where the assets are, then return the form to us. Failure

to respond by January 31, 2016 will result in 2016 Tax Bill.

___________________________

_________________________________________________________

Date Closed

Location of Assets

Please attach a list of any and all disposed items with this form.

Include the date of disposal, method of disposal, new owner

information (if available), and physical location of equipment.

Please sign below to acknowledge the attachment.

Signature ____________________________

Date_____________________

Annual Return To Woonsocket Form - R.i. Tax Assessor - 2016 Page 4