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Form Atd25 - Commercial / Agricultural/ Industrial Personal Property-Owned Declaration Schedule For 2009 Page 2

Form ATD25

State of Wyoming,

Page 2 of 2

COMMERCIAL / AGRICULTURAL/ INDUSTRIAL

PERSONAL PROPERTY—OWNED

DECLARATION SCHEDULE FOR 2009

Assessment Date: January 1, 2009

Date Due: March 1, 2009

County Number

Parcel #

Act Number

Personal Prop. Type

DO NOT USE - FOR ASSESSORS USE ONLY

Date received:

By:

Name and address of personal property listed here: (please make any corrections here)

Please indicate location of personal property: (please make any changes here)

PERSONAL PROPERTY YOU LEASE LOAN OR RENT LISTING: Please list only those items you are not responsible for here.

NAICS CODE:

( please indicate any changes by lining out the items that have been removed and filling in the new items purchased)

_______________

Owner and Address of Leased

Property Description

Cost of Leased Property

Term (From - To)

Annual Rent

Property

W.S. 39-13-107 (a)(i) I...the owner of (or agent, etc., as the case may be) do solemnly swear or affirm that the above and foregoing listed property is a full, true, correct

and complete list of all property owned by me or under my control as agent or otherwise, and that I have not failed or neglected to list for taxation for the year _____,

all property of which I am the owner of or of which I have control as agent, guardian, administrator or otherwise, in the county of________, State of Wyoming and that

I have not connived at any violation or evasion of the requirements of law in relation to the assessment of property for taxation. W.S. 18-3-205(b) Any person who

fails to return any taxable property owned by him or under his control is guilty of a misdemeanor and upon conviction shall be fined not exceeding five hundred dollars

($500.00), imprisoned in the county jail not exceeding ninety (90) days, or both.

Type or print your name here: _______________________________________________________________________________________________________

Signature of owner/agent___________________________________________________ Title ________________________Date _______________________

Telephone number ____________________________ Fax Number ___________________________________ Email: _______________________________

Form Atd25 - Commercial / Agricultural/ Industrial Personal Property-Owned Declaration Schedule For 2009 Page 2

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