15 DPT-AS Form
DO NOT USE – FOR ASSESSOR ONLY
State of Colorado
DS 058 08-12
RENEWABLE ENERGY PROPERTY
DECLARATION SCHEDULE
RECEIVED
(CONFIDENTIAL DATA)
COMPLETED
NO
LATE FILING PENALTY APPLIED
YES
RETURN TO COUNTY ASSESSOR
________________ County
SCHEDULE/ACCT.
B.A. CODE
T.A. CODE
Assessment Date
Due Date
NO.
January 1, 2012
April 15, 2012
A. NAME AND MAILING ADDRESS
BUSINESS NAME AND PHYSICAL LOCATION OF THE
(INDICATE ANY CHANGES OR CORRECTIONS)
RENEWABLE ENERGY PROPERTY AS OF JANUARY 1, 2012
CHECK HERE IF THERE ARE NO CHANGES FROM LAST YEAR’S DECLARATION SCHEDULE INFORMATION.
IF SO, GO DIRECTLY TO SECTION C. COMPLETE THE FORM, SIGN IT, AND RETURN FORM TO THE ASSESSOR.
B
ELECTRICAL GENERATION INFORMATION:
.
Total Number of Separate Renewable Energy Properties Owned in this County: __________
(If more than one, complete the following for each system. Attach additional sheets if necessary.)
Electric Generation Capacity
Date First Used to
Property Location and Address
Complete System Description
Generate Energy
(As declared in or converted to kW in AC)
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Attach to this form a copy / copies of any Solar Purchase Power / Net Metering Agreement(s), along with any Amendment(s).
C. DECLARATION
THIS RETURN IS SUBJECT TO AUDIT
“I declare, under penalty of perjury in the second degree, that this schedule, together with any accompanying exhibits or statements,
has been examined by me and to the best of my knowledge, information, and belief sets forth a full and complete list of all taxable
personal property owned by me, or in my possession, or under my control, located in this county, Colorado, on the assessment date
of this year; that such property has been reasonably described and its value fairly represented; and that no attempt has been made to
mislead the assessor as to its age, quality, quantity, or value.” § 39-5-107(2), C.R.S.
FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)/SOCIAL SECURITY NUMBER (SSN) _______________________________
NAME OF OWNER ___________________________________________________________________________________________
PRINT NAME OF PERSON SIGNING ____________________________________PHONE NUMBER _______________________
E-MAIL ADDRESS ___________________________________________________FAX NUMBER ___________________________
SIGNATURE OF OWNER OR AGENT ___________________________________________DATE __________________________
Check here if new agent. If new agent, submit a letter of authorization when filing this form.
PLEASE COMPLETE, SIGN AND RETURN TO THE ASSESSOR ON OR BEFORE APRIL 15, 2012.
MAKE A COPY FOR YOUR RECORDS.
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