Form Boe-571-L - Business Property Statement - 2009
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5BOE-571-L (S1F) REV. 13 (9-07)
SACRAMENTO COUNTY
KENNETH D. STIEGER, ASSESSOR
Personal Property Division
3701 Power Inn Road, Suite 3000
DECLARATION OF COSTS AND OTHER RELATED PROPERTY
Sacramento CA 95826-4329
INFORMATION AS OF 12:01 A.M. JANUARY 1, 2009
Telephone (916) 875-0730
FAX (916) 875-0735
FILE RETURN BY APRIL 1, 2009
LOCATION OF THE BUSINESS PROPERTY
NAME AND MAILING ADDRESS
(Make necessary corrections of the printed name and mailing address)
Business Name:__________________________________
Parcel # _______________________________________
Mailing Address: ________________________________
Physical Location in Sacramento County:
_________________________________
_____________________________________________
(file a separate statement for each location)
Complete (a) through (g).
f. Enter name and telephone no. of authorized person to contact at location of accounting
PART I GENERAL INFORMATION
a. Enter type of business:
records:
b. Enter local telephone no. (
)
FAX no. (
)
g. During the period of January 1, 2008 through December 31, 2008:
(1)
E-Mail Address (Optional):
?
Has all or part of this real property been subject to a change in ownership
@
YES
NO
(2)
c. Do you own the LAND at this business location?
Are any related entities conducting business in the county?
YES
NO
YES
NO
If yes, is the name on your deed recorded as shown on this statement?
If yes, provide name, mailing address, and locations:
YES
NO
d. When did you start business at this location? DATE:
(3)
If your business name or location has changed from last year, enter the former name
If you leased this real property, has it been the subject of a lease agreement
and/or location:
for a period of 35 years or more (including options)?
YES
NO
(4)
Did you acquire “control” through acquisition of stock or otherwise of a legal
e. Enter location of general ledger and all related accounting records (include zip code):
entity which owns real property in this county?
YES
NO
(5)
Did another person or entity acquire “control” through acquisition of stock or
otherwise of this corporation or entity?
YES
NO
COST
PART II DECLARATION OF PROPERTY BELONGING TO YOU
ASSESSOR’S USE ONLY
(OMIT CENTS)
(Attach schedule for any adjustment to cost)
SEE INSTRUCTIONS
FULL VALUE
TOTAL VALUE
1. Supplies
FIXTURES
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
PERSONAL PROPERTY
(From Line 71)
5. Construction in Progress
(Attach Schedule)
6. Alternate Schedule A
(
See Instructions)
7.
EXEMPTION
8.
ASSESSMENT TYPE
PRIOR YEAR FIXTURES
PRIOR YEAR PERSONALTY
PART III
DECLARATION OF PROPERTY BELONGING TO OTHERS
IF NONE, WRITE “NONE”
(SPECIFY TYPE BY CODE NUMBER)
Year
Year
Cost to
Report conditional sales contracts that are not leases on Schedule A
of
of
Description and Lease or
Annual
Purchase
1. Leased Equipment
4. Vending Equipment
Acq.
Mfr.
Identification Number
Rent
New
2. Lease-Purchase Option Equipment
5. Other Businesses
3. Capitalized Lease Equipment
6. Government - Owned Property
Tax Obligation:
A. Lessor
B. Lessee
9.
Lessor’s Name
Mailing Address
10. Lessor’s Name
Mailing Address
PROCESSING DATA
DECLARATION BY ASSESSEE
Ownership
ASSESSOR’S USE ONLY
Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.
Type
( )
Proprietorship
I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, including accompanying
By:
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
Partnership
to be reported which is owned, claimed, possessed, controlled, or managed by the person named as the assessee in this statement at 12:01 a.m. on
Corporation
Date:
January 1, 2009.
Other ________
Signature of Assessee or Authorized Agent*
Date
Computed:
Business
Name of Assessee or Authorized Agent *
Title
Telephone Number
(typed or printed)
Description
( )
Reviewed:
Retail
Name of Legal Entity
Federal Employer ID Number
(other than DBA) (typed or printed)
Wholesale
Billed:
Manufacturer
Preparer’s Name and Address
Telephone Number
(typed or printed)
Service/Prof.
Verified:
THIS STATEMENT SUBJECT TO AUDIT
*Agent: See page S4B for Declaration by Assessee instructions.
INFORMATION PROVIDED ON A PROPERTY STATEMENT MAY BE SHARED WITH THE STATE BOARD OF EQUALIZATION
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