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
No
May the department discuss this form with your preparer?
3