Form Boe-517-Tr - Declaration Of Costs And Other Related Property Information - 2013

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BOE-517-TR (S1F) REV. 15 (12-12)

STATE OF CALIFORNIA

PROPERTY STATEMENT—TELECOMMUNICATIONS—SHORT FORM

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.

IMPORTANT: PLEASE ANSWER THE FOLLOWING QUESTIONS BEFORE COMPLETING THE ATTACHED FORMS.

As of January 1, 2013:

In the course of your business, did you own, lease, or use real or personal property in California?

Yes

(If yes, skip question B, complete Schedules B, B-0, B-1, C, D)

(If no, answer question B, sign and return only this page.)

B. Were you conducting business in California?

Yes

(If yes, provide a copy of the most recent financial statements.)

(If no, sign and return only this front page form.)

C. In 2012, did you pay franchise fees (franchise fees based on a percentage of your cable or

Yes

video service revenues) to a local government for the right to provide cable or video television

services or make payments for the right to use public real property?

Name, address and phone number of person to whom correspondence regarding this property statement should be addressed:

NAME

EMAIL ADDRESS

ADDRESS

TELEPHONE NUMBER

FAX NUMBER

(

)

(

)

List business activities:

Has your company taken a FASB write-down to reflect a reduction in the value of your fixed assets?

Yes

If yes, enter the date the write-down was booked _______________________________________________________________

(4) ENTITY TYPE:

Proprietorship

Partnership

Corporation

Other

Change in ownership prior 12 months?

Yes

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 OF BUSINESS

PRINTED NAME OF SIGNATORY

TITLE

SIGNATURE OF OWNER, PARTNER, OR CORPORATE OFFICER

DATE

2013

SIGNATURE OF AUTHORIZED REPRESENTATIVE

DATE

2013

INFORMATION PROVIDED ON A PROPERTY STATEMENT MAY BE SHARED WITH OTHER STATE BOARD OF EQUALIZATION DEPARTMENTS