Annual Return To N. Smithfield Form - Ri Tax Assessor - 2016 Page 2

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2016
Annual Return to N. Smithfield, RI Tax Assessor
SECTION 10 REAL ESTATE OWNED
If You Need Additional Space Attach Addendum
The Law is Mandatory – A Return Must Be Filed (RI Law Section 44-5-15, as amended)
Assessor’s
Mail this form to: Tax Assessor, Town Hall, 575 Smithfield Rd., N. Smithfield, RI 02896
Claimed Full Value
LOCATION & DESCRIPTION
Plat
Lot
Land
Improvements
Statement of Valuation as of 12/31/2015
.
.
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.
For your convenience, we have supplied you with this form for the declaration of taxable property located in Rhode Island.
According to The General Laws of Rhode Island, taxable property must be declared to the Assessor between DECEMBER 31, 2015
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and
and JANUARY 31, 2016. If a taxpayer is unable to make such declaration within the prescribed time, they may submit written
statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer
notice, prior to JANUARY 31st, of intention to submit declaration by MARCH 15th. Failure to file a true and full account, within
(other than officer) is based on all information of which preparer has any knowledge.
th
the prescribed time, eliminates the right to appeal. No amended returns will be accepted after MARCH 15
.
Please
Sign
STATE LAW REQUIRES THE FILING OF THIS DECLARATION.
Here
FAILURE TO DO SO MAY RESULT IN AN INCREASED ASSESSMENT.
THIS FORM IS NOT SUBJECT TO PUBLIC INSPECTION.
Signature
Date
Title
Telephone #
I, ______________________________
My Residence Is: __________________________________________
On _______________________, _________________________ personally appeared before me and made oath that the
(Name)
______________________________
__________________________________________
foregoing account, by him/her signed and exhibited, contains to the best of his/her knowledge and belief, a true and full
am responsible for the
(Title)
account and valuation of all the ratable estate owned or possessed by said corporation, co-partnership, or individual.
information contained within this form.
My Daytime Phone Number Is: ________________________________
Signature of Notary Public and Date
Give a Full, General Description of Your Business Operation:
NAICS # _____________________
My Commission Expires: __________________
____________________________________________________________________________________________
 Mfg.
 Wholesale
 Retail
 Other: _____________
Date Business Began: ________________
Number of Employees as of December 31, 2015: ________
Square Feet Occupied: ________________
Do you own or lease the space occupied? ______________
Monthly Rent: ______________________
 Corporation
 Co-Partnership
 Individual  Other__________
Ownership:
NAME(s): _________________________________________________________________________
Business Name / DBA: _________________________________________________________________________
Business Address: _________________________________________________________________________
Mailing Address: _________________________________________________________________________

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