Form Ds 155a-61-12 - Residential Personal Property Declaration Schedule - 2013 Page 5
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5E. LIST ALL FULLY DEPRECIATED ASSETS / EXPENSED ITEMS: Attach a separate sheet including the appropriate Federal
Forms denoting all fully depreciated assets and expensed items. If you have none, write “None.”
Year
Year
Description
Acquired
Cost
Description
Acquired
Cost
1.
$
4.
$
2.
5.
$
$
3.
$
6.
$
F.
LEASED, LOANED, OR RENTED PROPERTY (Furniture, Signs, Etc.) Declare Personal Property Owned by Others.
Did you possess any leased, loaned, or rented machinery, equipment, furniture, signs, vending machines, etc., on January 1?
Yes
No
If you checked yes, list the items below, showing owner’s name, address, and telephone number; property description; etc. If any of the leased
equipment listed is capitalized on your books and records, please check the box at the beginning of the line corresponding with the name of the Lessor.
If additional room is needed, attach a complete listing of all leased personal property. If you checked no, go to Section G to complete this form.
Owner / Lessor’s Name,
Description Including
Term
Cost of Lease
Lease Number
Annual $ Rent
Address, Telephone Number
Model/Serial Number
(From-To)
Are purchase or maintenance options included in the total annual rent shown above?
Yes
No
If yes, please furnish details.
G. IS THERE ANY RENEWABLE ENERGY PROPERTY (e.g., solar panels, wind turbines, hydroelectric property) AT THIS
LOCATION?
Yes
No, IF YES, THE PROPERTY IS:
Owned
Leased, IF OWNED, COMPLETE THE DS 058 FORM.
H. DECLARATION
THIS RETURN IS SUBJECT TO AUDIT
“I declare, under penalty of perjury in the second degree, that this schedule, together with any accompanying exhibits or statements,
has been examined by me and to the best of my knowledge, information, and belief sets forth a full and complete list of all taxable
personal property owned by me, or in my possession, or under my control, located in this county, Colorado, on the assessment date
of this year; that such property has been reasonably described and its value fairly represented; and that no attempt has been made to
mislead the assessor as to its age, quality, quantity, or value.” § 39-5-107(2), C.R.S.
FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)/SOCIAL SECURITY NUMBER (SSN) _____________________________
NAME OF OWNER _____________________________________________________________________________________________________
PRINT NAME OF PERSON SIGNING _______________________________________PHONE NUMBER ______________________________
E-MAIL ADDRESS _______________________________________________________FAX NUMBER _________________________________
SIGNATURE OF OWNER OR AGENT ___________________________________________________ DATE __________________________
Check here if new agent. If new agent, submit a letter of authorization when filing this form.
PLEASE COMPLETE, SIGN AND RETURN TO THE ASSESSOR ON OR BEFORE APRIL 15, 2013.
.
MAKE A COPY FOR YOUR RECORDS
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