Form 571-R - Apartment House Property Statement

APARTMENT HOUSE PROPERTY STATEMENT

COUNTY OF LOS ANGELES • RICK AUERBACH, ASSESSOR

500 W. TEMPLE ST., ROOM 208, LOS ANGELES, CA 90012-2770

571-R

2005

Telephone: 213.974.7831 • Email: assessor@co.la.ca.us • Website: • 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, 2005)

ASSESSOR’S USE ONLY

ROUTING

SITUS

SUB

USE

TAX RATE

ASSESSOR’S IDENTIFICATION NUMBER

FILE RETURN BY

APRIL 1, 2005.

141

INDEX

TYPE

CODE

ACCT FORM

AREA

MAP BOOK

PAGE

PARCEL

ASSESSOR’S USE ONLY

RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED.

NAME AND MAILING ADDRESS

COMPANY NUMBER

(Make necessary corrections to the printed name and mailing address.)

LOCATION OF THE PROPERTY

(street, city)

(21

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):

Yes

Do you live in one of the units?

Yes

STREET

If yes, enter the unit number

CITY

STATE

ZIP

3. During the period of January 1, 2004 through December 31, 2004:

Enter name and telephone number of authorized person to contact at location of accounting records:

(a)

Did you own this real property?

Yes

(21

(b)

Has all or part of this real property been subject to a

Yes

change in ownership?

READ AND CAREFULLY FOLLOW THE ACCOMPANYING INSTRUCTIONS.

(c)

If you leased this real property, has it been the subject of

If you no longer own this property as of January 1 of this year, show the name and mailing

a lease agreement for a period of 35 years or more

address of the new owner:

(including options)?

Yes

Name

(d)

Did you acquire “control” of a legal entity which owns

Yes

real property in this county?

Mailing Address

(e)

Did another person or entity acquire “control” of this

corporation or entity? (see instructions)

Yes

City

Zip code

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

If yes, list below.

NAME AND ADDRESS OF OWNER OF SUCH PROPERTY

NATURE OF THE BUSINESS OR PROPERTY

Do you hold furniture or equipment belonging to others on a loan, rental or lease basis?

Yes

If yes, list below.

NAME AND ADDRESS OF OWNER OF SUCH PROPERTY

QUANTITY AND DESCRIPTION

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 on the back. Do not include, either here or in Schedule A, any unit in which you live.

USE ONLY

SLP. ROOM

STUDIO

1 BEDRM.

2 BEDRM.

3 BEDRM.

LARGER

. .

FULLY FURNISHED

. .

PARTLY FURNISHED

. .

UNFURNISHED

. .

TOTALS

. .

7. Supplies

. .

Cost

. .

8. Furniture and appliances

Enter From Schedule A

. .

9. Other furniture and equipment

Enter From Schedule B

. .

10.

. .

DECLARATION BY ASSESSEE

TOTAL FULL VALUE

. .

Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.

PERSONAL PROPERTY

. .

FIXTURES

. .

I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, including accompanying schedules,

. .

statements or other attachments, and to the best of my knowledge and belief it is true, correct, and complete and includes all property required to be reported

OTHER IMPROVEMENTS

. .

which is owned, claimed, possessed, controlled, or managed by the person named as the assessee in this statement at 12:01 a.m. on January 1, 2005.

. .

LAND

SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT*

DA TE

DEPUTY:

DATE

OWNERSHIP

TYPE (

)