Form Boe-571-L - Business Property Statement - 2009 printable pdf download

BUSINESS PROPERTY STATEMENT

BOE-571-L (S1F) REV. 13 (9-07)

571-L

DECLARATION OF COSTS AND OTHER RELATED PROPERTY INFORMATION

2009

AS OF 12:01 A.M., JANUARY 1, 2009

SLUC

BUSINESS ACCOUNT NUMBER

ROBERT C. WERNER

Fresno County Assessor

P. O. Box 1146 Fresno, CA 93715

ASSESSOR’S PARCEL NUMBER

SUB NUMBER

AS SESS O R ’ S U SE O N LY

FILE RETURN BY APRIL 1, 2009

LOCATION OF THE PROPERTY

(File a separate statement for each location.)

NAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address.)

IF YOU NEED ASSISTANCE, CALL (559) 488-3545.

RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED.

PART I: GENERAL INFORMATION

f. Enter name and telephone no. of authorized person to contact at location of accounting

records:

COMPLETE (a) THROUGH (g)

g. During the period of January 1, 2008 through December 31, 2008:

a. Enter type of business:

(1) Has all or part of this real property been subject to a change

b. Enter local telephone no. (

)

FAX number (

)

in ownership?

Yes

E-mail address (optional):

(2) Are any related entities conducting business in the county?

Yes

c. Do you own the land at this business location?

Yes

If yes, attach a list of names, mailing addresses, and locations.

If yes, is the name on your deed recorded

(3) If you leased this real property, has it been the subject of a lease agreement

as shown on this statement?

Yes

for a period of 35 years or more (including options)?

Yes

d. When did you start business at this location? DATE:

(4) Did you acquire “control” through acquisition of stock or otherwise of a legal

If your business name or location has changed from last year, enter the former name

entity which owns real property in this county?

Yes

and/or location:

(5) Did another person or entity acquire “control” through acquisition of stock or other-

e. Enter location of general ledger and all related accounting records (include zip code):

wise of this corporation or entity?

Yes

COST

PART II: DECLARATION OF PROPERTY BELONGING TO YOU

ASSESSOR’S USE ONLY

(omit cents)

(attach schedule for any adjustment to cost)

(see instructions)

1. Supplies

2. Equipment

(From line 35)

3. Equipment out on lease, rent or conditional sale to others

(Attach Schedule)

4. Bldgs., Bldg. Impr., and/or Leasehold Impr., Land Impr., Land

(From line 71)

5. Construction In Progress

(Attach Schedule)

6. Alternate Schedule A

(See instructions)

PART III: DECLARATION OF PROPERTY BELONGING TO OTHERS – IF NONE WRITE “NONE”

(SPECIFY TYPE BY CODE NUMBER)

Description

Year

Cost to

Report conditional sales contracts that are not leases on Schedule A

Annual

and Lease or

Purchase

Rent

5. Other businesses

Identification

1. Leased equipment

3. Capitalized leased equipment

Acq.

Mfr.

New



6. Government-owned property

Number

2. Lease-purchase option equipment

4. Vending equipment

Tax Obligation:

A. Lessor

B. Lessee



9. Lessor’s name

Mailing address

10. Lessor’s name

Mailing address

DECLARATION BY ASSESSEE

OWNERSHIP

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

(  )

TYPE

I declare under penalty of perjury under the laws of the State of California that I have examined this

ASSESSOR’S USE ONLY

Proprietorship

property statement, including accompanying schedules, statements or other attachments, and to the

Roll Changes

Partnership

best of my knowledge and belief it is true, correct, and complete and includes all property required to

Land

be reported which is owned, claimed, possessed, controlled, or managed by the person named as the

Corporation

assessee in this statement at 12:01 a.m. on January 1, 2009.

Other

Imps.

SIGNATURE OF ASSESSEE OR AUTHORIzED AGENT*

DATE



BUSINESS

(  )

Fix. (TFI)

DESCRIPTION

Retail

Per. Prop.

NAME OF ASSESSEE OR AUTHORIzED AGENT* (typed or printed)

TITLE

Wholesale

Ex.

Manufacturer

NAME OF LEGAL ENTITY (other than DBA) (typed or printed)

FEDERAL EMPLOYER ID NO.

Service/Professional

Ex.

ASSESSOR’S USE ONLY

Ex.

PREPARER’S NAME AND ADDRESS (typed or printed)

TELEPHONE NUMBER TITLE

Pen.

(

)

Appr.

*Agent: See S3B for Declaration By Assessee instructions

THIS STATEMENT SUBJECT TO AUDIT

INFORMATION PROVIDED ON A PROPERTY STATEMENT MAY BE SHARED WITH THE STATE BOARD OF EqUALIzATION

! 0 9 5 7 1 L !

571-L 2009

Form Boe-571-L - Business Property Statement - 2009

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