Business Personal Property Reporting Form - Montana Department Of Revenue - 2014 Page 3

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Tax Year: 2014

Owner Name: _______________________________________

Address: ___________________________________________

Assessment Code: ___________________________________

County: ____________________________________________

Tax Year 2014 Personal Property Reporting Form

Please submit your completed and signed form on or before March 1, 2014.

Contact Information

Contact /Preparer Name ___________________________________________________________ Email ________________________________________

Phone Number ________________________________

Cell ____________________________

Fax _____________________________

Property Information – If business name, type of business or business location are blank, please provide this information.

Property ID __________________________ Assessment Code ___________________________ Levy District __________________________

Business Name ____________________________________________________________ Type of Business _____________________________________

Related Party ID ____________________________ Key Code ____________________________

Business Location (if applicable) __________________________________________________________________________________________

If any of the following statements apply, please provide the requested information.

Business Closed (Date) ______________________

Business/Farm/Ranch was Sold (To Whom) ___________________________________________________________________________________

Business/Farm Equipment Moved (New Location) ______________________________________________________________________________

Additions/Deletions of Buildings or Mobile Homes (Explain) _______________________________________________________________________

Livestock moved (New Location) ____________________________________________________________________________________________

Changes in Land Use (Explain) _____________________________________________________________________________________________

Mailing address change ___________________________________________________________________________________________________

Afﬁ davit and Signature – this page must be completed and submitted with the reporting form.

I swear, under penalty of false swearing, that I have examined this reporting form (including the accompanying tables and instructions) and, to the best of my

knowledge and belief, it is true, correct and complete.

Authorized Signature ______________________________________________________________

Date ___________________________

Property Owner’s Business FEIN ________________________ or Property Owner’s SSN________________________

Parent Company Name (if applicable) ____________________________________________

Parent Company FEIN (if applicable) _____________________

If 50% of your business is owned by a parent company, you must also provide the business name and FEIN of the parent company.

Yes

May the department discuss this form with your preparer?