BUSINESS PERSONAL PROPERTY LISTING

Transcription

1 TO AVOID PENALTY RETURN BY JANUARY 31,. PERSONAL PROPERTY (SEE INSTRUCTIONS) GROUP (2) OFFICE FURNITURE & FITURES YR. ACQUIRED YR. ADDITIONS DELETIONS CURR. YR. YR. ACQUIRED YR. ADDITIONS DELETIONS CURR. YR. GROUP (4) LEASEHOLD IMPROVEMENTS YR. ACQUIRED YR. ADDITIONS DELETIONS CURR. YR. GROUP (7) CONSTRUCTION IN PROGRESS LIST IN DETAIL ALL EPENDITURES IN CIP ACCOUNT ON JANUARY 1, BUT NOT INCLUDED ABOVE - SEE INSTRUCTIONS CIP: $ STATE OF NORTH CAROLINA LISTING # RETURN TO: CLEVELAND COUNTY ASSESSOR, BUSINESS SECTION, P.O. BO 370, SHELBY, NC PHONE: (704) FOR DEPARTMENT USE ONLY = = = > PENALTY ACCOUNT NUMBER DISTRICT CODE VALUE QUESTIONS? TELEPHONE OR ANNA.MCCALL@CLEVELANDCOUNTY.COM PHYSICAL ADDRESS REAL ESTATE OWNED BY LOCATION OF ACCOUNTING RECORDS DATE BUSINESS BEGAN IN THIS COUNTY FED. ID # DATE BUSINESS (FISCAL) ENDS PRINCIPAL BUSINESS OR NAICS CODE NAME IN WHICH BUSINESS WAS LISTED LAST : CHECK ONE > CORPORATION SOLE PROPRIETORSHIP PARTNERSHIP UNINCORPORATED ASSOCIATION OTHER (SPECIFY) CHECK BUSINESS CATEGORY > RETAIL WHOLESALE MANUFACTURING SERVICE LEASING/RENTAL FARMING OTHER (SPECIFY) OTHER N.C. COUNTIES WHERE PERSONAL PROPERTY IS LOCATED CONTACT PERSON FOR AUDIT: ADDRESS & PHONE IF OUT OF BUSINESS COMPLETE THIS SECTION = = > DATE CEASED CHECK ONE: SOLD CLOSED BANKRUPT OTHER SOLD EQUIPMENT / FITURES / SUPPLIES TO: BUYER S ADDRESS & PHONE: GROUP (3) COMPUTER EQUIPMENT YR. ACQUIRED YR. ADDITIONS DELETIONS CURR. YR. GROUP (5) EPENSED ITEMS (cap thresh ) YR. ACQUIRED YR. ADDITIONS DELETIONS CURR. YR. GROUP (6) OTHER - DESCRIBE YR. ACQUIRED YR. ADDITIONS DELETIONS CURR. YR. GROUP (8) SUPPLIES SEE INSTRUCTIONS SUPPLIES ON HAND JANUARY 1, AT Office, Medical, Dental, Beauty, Maintenance, etc. Fuels of all kinds Spare parts for equipment Expensed Items All other Total $

2 VEHICULAR EQUIPMENT - SEE INSTRUCTIONS GROUP (1) UNTAGGED VEHICLES, MULTI REGISTERED TRAILERS AND 3 MO. FARM TAGS If you need additional space to list property under Schedules B, C, and D, please attach a separate report in the same format as below. Write see attached on the schedules if this is necessary. (Additional pages are attached for pre-listed property that exceeds the number of spaces available in these Schedules.) MAKE MODEL BODY/SIZE TITLE # VEHICLE ID. NUMBER (VIN) SPEC. BODY FOR OFFICE USE GROUP (2) S & S TYPE / MAKE / MODEL LENGTH/SIZE REGIS. # LOCATION ENGINE TYPE ORIGINAL PURCHASED FOR OFFICE USE HP GROUP (3) AIRCRAFT MAKE MODEL SERIAL # LOCATION FAA # ORIGINAL PURCHASED FOR OFFICE USE GROUP (4) MANUFACTURED HOMES & OFFICES MAKE WIDTH/LENGTH TITLE ID. NUMBER (VIN) ORIGINAL PURCHASED FOR OFFICE USE SCHEDULE C STATEMENT OF LEASED EQUIPMENT AS OF JANUARY 1 NAME AND ADDRESS OF OWNER DESCRIPTION OF PROPERTY LEASE # OR ACCOUNT # MONTHLY PAYMENT NEW (QUOTED) START & END LEASE DATES SCHEDULE D ACQUISITIONS AND/OR DISPOSALS OF MACHINERY, EQUIPMENT, FURNITURE AND FITURES IN THE (ATTACH SCHEDULE IF NECESSARY) ACQUISITIONS - ITEMIZE IN DETAIL DISPOSALS - ITEMIZE IN DETAIL 100% ORIGINAL INSTALLED ACQUIRED 100% ORIGINAL REAL ESTATE IMPROVEMENTS During the past calendar year, did your business make improvements and/or other additions to real property, owned by you business? If yes, attach a separate schedule with information on such improvements. Yes No AFFIRMATION LISTING FORM MUST BE SIGNED BY A LEGALLY AUTHORIZED PERSON - SEE INSTRUCTIONS Under penalties prescribed by law, I hereby affirm that to the best of my knowledge and belief this listing, including any accompanying statements, inventories, schedules, and other information, is true and complete. (If this affirmation is signed by an individual other than taxpayer, he affirms that he is familiar with the extent and true value of all the taxpayer s property subject to taxation in this county and that his affirmation is based on all the information of which he has any knowledge.) SIGNATURE DATE PREPARER OTHER THAN TAPAYER DATE PRINT OR TYPE NAME PRINT OR TYPE NAME TITLE TELEPHONE NUMBER ADDRESS TELEPHONE NUMBER Any individual who willfully makes and subscribes an abstract listing required by this Subchapter (of the Revenue Laws) which he does not believe to be true and correct as to every material matter shall be guilty of a Class 2 misdemeanor.

3 ACQUIRED ADDITIONS DELETIONS CURR. ACQUIRED ADDITIONS DELETIONS CURR. (Additional Schedule A) ACQUIRED ADDITIONS DELETIONS CURR. ACQUIRED ADDITIONS DELETIONS CURR. CLVAB3.IMG

4 VEHICULAR EQUIPMENT GROUP (1) UNTAGGED VEHICLES, AND MULTI TAGGED TRAILERS; 3 MO FARM TAGS MAKE MODEL BODY / SIZE TITLE # VEHICLE ID NUMBER (VIN) SPEC. BODY FOR OFFICE USE CLVAB4.IMG

5 GROUP (2) S & S ORIGINAL TYPE / MAKE / MODEL LENGTH/SIZE REGIS # LOCATION ENGINE TYPE PURCHASED FOR OFFICE USE CLVAB5.IMG

6 GROUP (3) AIRCRAFT MAKE MODEL SERIAL# LOCATION FAA # ORIGINAL PURCHASED FOR OFFICE USE CLVAB6.IMG

7 MAKE WIDTH/LENGTH TITLE VEHICLE ID NUMBER (VIN) ORIGINAL FOR OFFICE USE PURCHASED GROUP (4) MANUFACTURED HOMES & OFFICES ACCOUNT NUMBER CLVAB7.IMG