Form Ls-001 - Lessor Data Report - Wisconsin Department Of Revenue Page 2

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Lessor Data Report
Page
of
(See instructions on front.)
Lessor Name
Address
Column 1
Column 2
Column 3
Column 4
Column 5
Column 6
Column 7
Column 8
Year
Cost or Price (Per Unit in Col. 3)
Gross Rent
January 1
Name of Lessee
Inception Date
Type of Equipment, Brand
1 = Current Selling Price New
Declared Value
Mfg = Year Mfg.
Mon = Monthly
2 = Original Selling Price
Equipment Location (Address)
Name and Model No.
Quantity
Length of Lease
(Per Unit in Col. 3)
Acqd = Yr. Acquired
Annl = Annually
3 = Cost of Acquisition
4 = Selling Price Per Lease
Mfg
Acqd
1
2
3
4
Mon
Annl
Mfg
Acqd
1
2
3
4
Mon
Annl
Mfg
Acqd
1
2
3
4
Mon
Annl
Mfg
Acqd
1
2
3
4
Mon
Annl
Mfg
Acqd
1
2
3
4
Mon
Annl
Mfg
Acqd
1
2
3
4
Mon
Annl
Mfg
Acqd
1
2
3
4
Mon
Annl
Mfg
Acqd
1
2
3
4
Mon
Annl
Mfg
Acqd
1
2
3
4
Mon
Annl
Mfg
Acqd
1
2
3
4
Mon
Annl
Mfg
Acqd
1
2
3
4
Mon
Annl
IMPORTANT: Please indicate those accounts with an asterisk which are being capitalized by the lessee.
LS-001 (R. 10-02)
Wisconsin Department of Revenue

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