BOE-517-LE (S1F) REV. 17 (12-12)
STATE OF CALIFORNIA
PROPERTY STATEMENT—LOCAL EXCHANGE TELEPHONE COMPANIES
BOARD OF EQUALIZATION
2013
DECLARATION OF COSTS AND OTHER RELATED PROPERTY INFORMATION
AS OF 12:01 A.M., JANUARY 1, 2013
This statement must be completed, signed, and filed with the State-Assessed Properties Division, Board of Equalization,
P.O. Box 942879, Sacramento, California 94279-0061, by March 1, 2013. Omit cents; round to the nearest dollar.
OFFICIAL REQUEST
NAME, STREET, CITY, STATE and ZIP CODE
This request is made in accordance with section 826 of the Revenue
and Taxation Code. This property statement must be completed
according to the instructions and filed with the Board of Equalization
(BOE) on or before March 1, 2013. If you do not file this statement
you may be subject to the penalty provided in section 830 of the
Revenue and Taxation Code. Attached schedules are considered to
be part of the statement. THIS STATEMENT IS SUBJECT TO AUDIT.
SBE No.
MAKE NECESSARY CORRECTIONS TO ADDRESS LABEL
Indicate if above is a change of name and/or address.
Name and address of person to whom correspondence
DATE
DATE TO BE
N/A
THIS STATEMENT SHALL CONSIST OF:
SUBMITTED
SUBMITTED
regarding audit should be addressed:
NAME
(1)
Tangible Property List
(2)
Summary Control
MAILING ADDRESS (including zip code)
(3)
Statement of Land Changes
(4)
Financial Schedules A to E
TELEPHONE NUMBER
(
)
(5)
Schedule of Intangible Information
EMAIL ADDRESS
(6)
Schedule of Miles of Fiber
Optic Right of Way
LOCATION OF ACCOUNTING RECORDS (street, city, state and zip code)
(7) Schedules of Leased
BOE-600-A
Equipment
BOE-600-B
(8) Other Information as Requested
(see instructions on reverse)
a.
Payments to Local Governments
b.
Statement of Rev/Cost Changes
NAME OF AUTHORIZED REPRESENTATIVE (if applicable)
c.
Annual Rept. to Federal Agencies
ADDRESS (street, city, state and zip code)
d.
Annual Rept. to State Agencies
e.
Form 10K
DAYTIME TELEPHONE NUMBER
f.
Shareholders Report—3 copies
(
)
g.
Working Cash Statement
EMAIL ADDRESS
h.
Inventory Data
i.
Other
* BOE-892, Statement of Authorization, must be filed annually.
List business activities:
(4) ENTITY TYPE:
Proprietorship
Partnership
Corporation
Other
Change in ownership prior 12 months?
Yes
No
CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California that I have examined this Property Statement, including accompanying schedules
and statements, and to the best of my knowledge and belief it is true, correct, and complete and covers all property required to be reported which is owned, claimed,
possessed, controlled, or managed by the person named in the statement at 12:01 a.m. on January 1, 2013. If prepared by a person other than the taxpayer, this
declaration is based on all information of which preparer has knowledge.
FOR OFFICIAL USE ONLY
FULL LEGAL NAME IF INCORPORATED
SIGNATURE OF OWNER, PARTNER, OFFICER, OR AUTHORIZED AGENT
DATE
2013
PRINTED NAME OF SIGNATORY
TITLE
SIGNATURE AND ADDRESS OF PREPARER OTHER THAN TAXPAYER
DATE
2013
INFORMATION PROVIDED ON A PROPERTY STATEMENT MAY BE SHARED WITH OTHER STATE BOARD OF EQUALIZATION DEPARTMENTS
CONTINUE