Form Boe-571-L - Business Property Statement For 2006

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2006
BOE-571-L (S1F) REV. 10 (8-05)
BUSINESS PROPERTY
STATEMENT FOR 2006
(Declaration of costs and other related
property information as of 12:01 A.M.,
January 1, 2006)
RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED.
NAME AND MAILING ADDRESS
(Make necessary corrections to the printed name and mailing address.)
FILE RETURN BY APRIL 1, 2006
LOCATION OF THE PROPERTY
STREET
CITY
(File a separate statement for each location.)
PART I:
GENERAL INFORMATION
f.
Enter name and telephone number of authorized person to contact at location of
accounting records:
COMPLETE (a) THRU (g)
a. Enter type of business:
g. During the period of January 1, 2005 through December 31, 2005:
b. Enter local telephone number (
)
FAX number (
)
(1) Has all or part of this real property been subject to a change in ownership?
E-Mail Address (optional)
Yes
No
c. Do you own the land at this business location?
Yes
No
(2) Are any related entities conducting business in the county?
Yes
No
If yes, is the name on your deed recorded
If yes, provide name, mailing address, and locations:
as shown on this statement?
Yes
No
(3) If you leased this real property, has it been the subject of a lease agreement for a
d. When did you start business at this location? DATE:
period of 35 years or more (including options)?
Yes
No
If your business name or location has changed from last year, enter the former name
(4) Did you acquire “control” through acquisition of stock or otherwise of a legal entity
and/or location:
which owns real property in this county?
Yes
No
(5) Did another person or entity acquire “control” through acquisition of stock or
e. Enter location of general ledger and all related accounting records (include zip code):
otherwise of this corporation or entity?
Yes
No
COST
ASSESSOR’S USE ONLY
PART II: DECLARATION OF PROPERTY BELONGING TO YOU
(omit cents)
(attach schedule for any adjustment to cost)
(see instructions)
1. Supplies
2. Equipment
(From line 35)
3. Equipment on lease, rent, or conditional sale to others
(Attach Schedule)
4. Bldgs., Bldg. Impr., and/or Leasehold Impr., Land Impr., Land
(From line 71)
(Attach Schedule)
5. Construction In Progress
(See instructions)
6. Alternate Schedule A
7.
8.
PART III: DECLARATION OF PROPERTY BELONGING TO OTHERS – IF NONE WRITE “NONE”
(SPECIFY TYPE BY CODE NUMBER)
Year
Year
Description
Cost to
Annual
Report conditional sales contracts that are not leases on Schedule A
of
of
and Lease or
Purchase
Rent
1. Leased equipment
4. Vending equipment
Acq.
Mfr.
Identification
New
2. Lease-purchase option equipment
5. Other businesses
Number
3. Capitalized leased equipment
6. Government-owned property
Tax Obligation:
A. Lessor
B. Lessee
9. Lessor’s name
Mailing address
10. Lessor’s name
Mailing address
DECLARATION BY ASSESSEE
OWNERSHIP TYPE (✓)
Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.
ASSESSOR'S USE ONLY
Proprietorship
I declare under penalty of perjury under the laws of the State of California that I have examined this property
Partnership
ANALYZED
statement, including accompanying schedules, statements or other attachments, and to the best of my knowledge
Corporation
and belief it is true, correct, and complete and includes all property required to be reported which is owned,
Other ______________
claimed, possessed, controlled, or managed by the person named as the assessee in this statement at 12:01 a.m.
CHANGES
on January 1, 2006.
BUSINESS
SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT*
DATE
APPRAISED
DESCRIPTION
(✓)
Retail
NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed)
TITLE
COMPUTED
Wholesale
Manufacturer
NAME OF LEGAL ENTITY (other than DBA)(typed or printed)
FEDERAL EMPLOYER ID NUMBER
REVIEWED
Service/Professional
PREPARER’S NAME AND ADDRESS (typed or printed)
TELEPHONE NUMBER
TITLE
POSTED
(
)
THIS STATEMENT SUBJECT TO AUDIT
* Agent: See page S4B for Declaration by Assessee for instructions.

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