Business Personal Property Listing Form - Guilford County

GUILFORD COUNTY

2004

(1)

TAX DEPARTMENT

PO BOX 3138

North Carolina

PO BOX 698

GREENSBORO NC 27402-3138

HIGH POINT NC 27261-0698

BUSINESS PERSONAL PROPERTY LISTING FORM

FILING STATUS

LISTING NUMBER

MUNICIPALITY

TOWNSHIP

SPECIFY PRINCIPAL BUSINESS ACTIVITY IN GUILFORD COUNTY

CORPORATION

d p

PROPRIETORSHIP

NAME 1 (ATTACH MAILING LABEL SEE INSTRUCTIONS)

LOCATION OF PROPERTY (STREET ADDRESS)

PARTNERSHIP

UNINCORPORATED

NAME 2

DATE BUSINESS YEAR ENDS

DATE BUSINESS COMMENCED HERE

ASSOCIATION

OTHER (SPECIFY)

ADDRESS 1

PERSON TO CONTACT FOR AUDIT (NAME, ADDRESS, TELEPHONE)

BUSINESS CATEGORY

ADDRESS 2

STATE OF INCORPORATION

FEIN OR SOCIAL SECURITY NUMBER

RETAIL

WHOLESALE

CITY, STATE, ZIP

FORMER OWNER IF PROPERTY WAS LISTED BY ANOTHER IN 2003

MANUFACTURING

SERVICE

PARTNERSHIP OR UNINCORPORATED ASSOCIATION - NAMES AND ADDRESSES OF PARTNERS OR PRINCIPALS (ATTACH SCHEDULE IF NECESSARY)

OTHER (SPECIFY)

OTHER NC COUNTIES IN WHICH YOU FILED A BUSINESS PROPERTY RETURN (ATTACH SCHEDULE IF NECESSARY)

IF OUT OF BUSINESS COMPLETE THIS SECTION

CHECK ONE:

SOLD EQUIPMENT / FIXTURES / SUPPLIES TO (GIVE BUYER’S NAME, ADDRESS & PHONE)

SOLD ______

CLOSED ______

DATE OPERATIONS CEASED ______ / ______ / ______

BANKRUPT ______

OTHER ______

SCHEDULE A - SUPPLIES AND EXPENSED ITEMS AS OF JANUARY 1

DEPARTMENT USE ONLY

DO NOT USE AN ARBITRARY FIGURE. EXPENSE AND OTHER DOCUMENTATION MAY BE REQUIRED TO SUBSTANTIATE ALL ENTRIES.

APPRAISER

TWP

1. OFFICE, MAINTENANCE, JANITORIAL, MEDICAL, DENTAL, BARBER AND BEAUTY SUPPLIES

2. FUELS HELD FOR CONSUMPTION

FMEQ

3. REPLACEMENT PARTS OR SPARE PARTS

MVEH #

4. RESTAURANT AND HOTEL ITEMS SUCH AS LINENS AND COOKWARE NOT LISTED IN SCHEDULE B

OVEH #

5. RENTAL ITEMS NOT SOLD IN THE NORMAL COURSE OF BUSINESS AND NOT LISTED IN SCHEDULE B

MOBH #

6. ALL OTHER MISCELLANEOUS SUPPLIES NOT LISTED ABOVE

ACFT #

TOTAL

SUP

7. DISPLAY ITEMS INCLUDING FINISHED GOODS INVENTORIES COMMITTED

2003

FNFX

TO USE PRIOR TO ULTIMATE SALE OR DISPOSITION. LIST BY YEAR OF

2002

OTHER 1

ACQUISITION. ATTACH SEPARATE SCHEDULE IF NECESSARY

PRIOR

OTHER 2

2003

8. EXPENSED ITEMS:

LIST TOTAL AMOUNT ON HAND BY YEAR ACQUIRED

TOTAL

CAPITALIZATION THRESHOLD: __________________

2002

(SECTION 179 EXPENSED ITEMS SHOULD BE REPORTED IN SECTION B)

PRIOR

SCHEDULE B - MACHINERY, EQUIPMENT, FURNITURE, FIXTURES, COMPUTERS, SOFTWARE, LEASEHOLD IMPROVEMENTS & CIP

LIST AT TOTAL COST BY YEAR OF ACQUISITION INCLUDING ALL FULLY DEPRECIATED ASSETS AS OF JANUARY 1. ATTACH SEPARATE SCHEDULES IF NECESSARY.

YEAR OF

MACHINERY &

FURNITURE &

COMPUTER EQUIPMENT

LEASEHOLD

ACQUISITION

EQUIPMENT

FIXTURES

& SOFTWARE

IMPROVEMENTS

TOTAL

DEPARTMENT USE ONLY

2003

2002

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

1991

1990

1989

PRIOR

TOTAL

CIP.

PERSONAL PROPERTY CONSTRUCTION IN PROGRESS AS OF JANUARY 1 AT 100% COST INCURRED TO DATE

AFFIRMATION OF TAXPAYER

Under penalties prescribed by law, I hereby affirm that to the best of my knowledge and belief this listing, including any accompanying statements, inventories, schedules, and other information, is true and complete. If this

affirmation is signed by an individual other than the taxpayer, he affirms that he is familiar with the extent and true value of all the taxpayer’s property subject to taxation in this county and that his affirmation is based on all

the information of which he has any knowledge. Listing MUST be signed by a principal officer or full-time employee of taxpayer.

SIGNATURE

DATE

PREPARER OTHER THAN TAXPAYER

DATE

TITLE

TELEPHONE NUMBER

ADDRESS