Form Boe-571-L - Business Property Statement - 2004

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BOE-571-L (S1F) REV. 8 (8-03)
SACRAMENTO COUNTY
KENNETH D. STIEGER, ASSESSOR
3701 Power Inn Road, Suite 3000
Sacramento CA 95826-4329
DECLARATION OF COSTS AND OTHER RELATED PROPERTY
Telephone (916) 875-0730
INFORMATION AS OF 12:01 A.M. JANUARY 1, 2004
FAX (916) 875-0735
RETURN THIS ORIGINAL BY APRIL 1 2004
LOCATION OF THE PROPERTY
(Make necessary corrections of the printed name and mailing address)
(file a separate statement for each location)
PART I GENERAL INFORMATION
Complete (a) through (g).
f. Enter name and telephone no. of authorized person to contact at location of accounting
a. Enter type of business:
records:
b. Enter local telephone No. (
)
FAX No. (
)
g. During the period of January 1, 2003 through December 31, 2003:
(1)
E-Mail Address (Optional)
@
?
Has all or part of this real property been subject to a change in ownership
YES
NO
YES
NO
(2)
c. Do you own the LAND at this business location?
Are any related entities conducting business in the county?
YES
NO
If YES, is the name on your deed recorded as shown on this statement?
YES
NO
If yes, provide name, mailing address and locations:
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
YES
NO
and/or location:
for a period of 35 years or more (including options)?
(4)
Did you acquire “control” through acquisition of stock or otherwise of a legal
YES
NO
e. Enter location of general ledger and all related accounting records (include zip code):
entity which owns real property in this county?
(5)
Did another person or entity acquire “control” through acquisition of stock or
YES
NO
otherwise of this corporation or entity?
PART II DECLARATION OF PROPERTY BELONGING TO YOU
COST
ASSESSOR’S USE ONLY
(OMIT CENTS)
(Attach Schedule For Any Adjustment To Cost)
SEE INSTRUCTIONS
FULL VALUE
TOTAL VALUE
FIXTURES
1. Supplies
2. Equipment
(From Line 35)
3. Equipment Out on Lease or Rent to Others
(Attach Schedule)
PERSONAL PROPERTY
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
EXEMPTION
7.
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
Purchase
Annual
1. Leased Equipment
4. Vending Equipment
Acq.
Mfr.
Identification Number
New
Rent
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
DECLARATION BY ASSESSEE
ASSESSOR’S USE ONLY
Ownership
Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.
(ü)
Type
q
I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, including accompanying
By
Proprietorship
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
q
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
Date
q
Corporation
January 1, 2004.
q
Other ________
Signature of Assessee or Authorized Agent*
Date
Computed
Business
Name of Assessee or Authorized Agent *
(typed or printed)
Title
Telephone Number
Description
(ü)
Reviewed
q
Retail
Name of Legal Entity
(other than DBA) (typed or printed)
Federal Employer ID Number
q
Wholesale
Billed
q
Manufacturer
Preparer’s Name and Address
Telephone Number
(typed or printed)
q
Service/Prof.
Verified
*Agent: See page S4B for Declaration by Assessee for instructions.
THIS STATEMENT SUBJECT TO AUDIT

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