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WHO TO CONTACT
For Additional Registrations:
-Call Strafford Customer Service 1-800-926-7926 x10 (or 404-881-1141 x10)
For Assistance During the Program:
-On the web, use the chat box at the bottom left of the screen
If you get disconnected during the program, you can simply log in using your original instructions and PIN.
IMPORTANT INFORMATION
This program is approved for 2 CPE credit hours. To earn credit you must:
• Participate in the program on your own computer connection (no sharing) – if you need to register
additional people, please call customer service at 1-800-926-7926 x10 (or 404-881-1141 x10). Strafford
accepts American Express, Visa, MasterCard, Discover.
• Listen on-line via your computer speakers.
• Respond to five prompts during the program plus a single verification code. You will have to write down
only the final verification code on the attestation form, which will be emailed to registered attendees.
• To earn full credit, you must remain connected for the entire program.
Business Personal Property
Tax Compliance: Key Fundamentals Understanding Key Dates and Deadlines, Assessment Ratios, Market Valuations and Other Essentials
THURSDAY, MARCH 3, 2016, 1:00-2:50 pm Eastern
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In the Hartford History Center's 1:011tctions are the town/city archives. In 1871, Samuel L. Clemens, aka Mark Twain, filled out his taxable property sheet, noting various values. Under "Dogs, number and kind," he added "1, male, spotted, worthless." (The dog's name was flash.)
135
2015 Connecticut Declaration of Personal Property
Filing Requirement — This declaration must be filed with the Assessor of the town where the personal property is located. Declarations of personal property shall be made annually.
If you no longer own the above noted business or personal property assessed in your name last year, you do not need to complete this declaration. You must, however, return this declaration to the Assessor and provide information related to the name of the new owner of the property or the date your business ceased or to where you moved the business (see Affidavit below). Otherwise, the Assessor must assume that you are still ape' ating the business and still own and have failed to declare your taxable personal property.
AFFIDAVIT OF BUSINESS TERMINATION OR MOVE OR SALE OF BUSINESS OR PROPERTY
of at Business or property owners name Business Name (if applicable) Street location
With regards to said business or property I do so certify that on Said business or property was (indicate which one by circling) Date
SOLD TO: Name
MOVED TO:
Address
City/Town and State to where business or property was moved Address
TERMINATED: I Attach Bill of Sale or Letter of dissolution to this form and return it with this affidavit to the Assessor's office
The signer is made aware that the penalty for making a false affidavit is a $500.00 fine or imprisonment for one year or both.
Signature Print name
Penalty for late filing — Failure to file timely will result in a penalty equal to 25% of the assessment of the personal property. This declaration must be filed or postmarked (as defined in C.G.S. Sec 1-2a & as referenced in Sec. 12-41(d)) no later than:
Monday, November 2, 2015
INSTRUCTIONS As per CGS 12-63, the Assessor must determine the "present true and actual value" and in determining such value may use the accepted methods of comparable sales, cost less depreciation and income capitalization.
Not all sections are applicable to every business. Please read the following instructions and complete all relevant sections.
Who Should File -- All owners of taxable personal property.
Declaration - 1. Owners of:
a. Non-Connecticut registered motor vehicles b. Horses, ponies and thoroughbreds c. Mobile manufactured home -not assessed as real estate
2. Businesses, occupations, farmers, and professionals need to complete: (Commercial and cost information is not open to public inspection )
• Business Data (page 3). • Lessee's Listing Report (page 4). • Disposal, Sale or Transfer of Property Report (page 4) • Taxable Property Information (pages 5-7). • Sign the Declaration of Personal Property Affidavit
on page 8. 3. Lessors need to complete: (Commercial and cost information
is not open to public inspection ) • Business Data (page 3). • Lessor's Listing Report (page 3) • Disposal, Sale or Transfer of Property Report (page 4) • Taxable Property Information (pages 5-7). • Sign the Declaration of Personal Property Affidavit
on page 8.
Filing Requirements - 1. The Personal Property Declaration must be filed annually on
or before November 1 (or the Monday following if November 1 falls on Saturday or Sunday) (CGS §12-42).
2. A Personal Property Declaration not filed will result in a value determined by the Assessor from the best available information (CGS §12-53b).
3. Declarations filed with "same as last year" are INSUFFICIENT and shall be considered an incomplete declaration.
4. Manufacturing machinery and equipment or biotechnology machinery and equipment eligible for exemption under CGS 12-81 (72) & (76) were previously declared under Codes 13 & 15. Those items are declared under Code 13 for all years.
Penalty of 25% is Applied - 1. When no declaration is filed or a declaration is not signed, a
25% penalty is applied to the assessment. [See 2. under Filing Requirements.]
2. When declarations are submitted after November 1 [See 1. under Filing Requirements] and an extension has NOT been granted (see Extensions) a 25% penalty is applied to the assessment. Returns mailed in must have a postmark (as
defined in C.G.S. Sec 1-2a) of November 1 [See 1. under Filing Requirements.] or before.
3. When an extension is granted (see Extensions) and the declaration is not filed by the extension deadline, a 25% penalty is applied to the assessment.
4. When omitted property is discovered, the 25% penalty is applied to the difference in the assessed value as determined by the results of the discovery and the assessment as determined by the originally filed declaration.
Exemptions- 1. On page 7, check the box adjacent to the exemption you are
claiming. 2. Note that several exemptions require an additional application
in order to receive that exemption. Please request the form number noted from the Assessor's Office. The Manufacturers Machinery & Equipment Exemption Claim form & its itemized lists for Code 13 property may be requested if not included with this declaration.
3. The extension to file the Personal Property Declaration, if granted, may not apply to all required exemption applications and may require a late filing fee. Check with the Assessor.
Signature Required - 1. The owners shall sign the declaration (page 8). 2. The owner's agent may sign the declaration. In which case
the declaration must be duly sworn to or notarized. 3. Corporate officers signing for their corporations must have the
returns properly sworn to or notarized; or provide the Assessor with a statement bearing the corporate seal and signed by the corporate secretary setting out the office held by the signer of the declaration and dates office held.
Extension - The Assessor may grant a filing extension for good cause (CGS §12-42 &12-81K ). If a request for an extension is needed, you need to contact the Assessor in writing by the required filing date [See 1. under Filing Requirements].
Audit - The Assessor is authorized to audit declarations, within 3 years of the date of the required filing. Substantial penalties are applicable if such an audit reveals property not declared as required by law (CGS §12-53).
Before Filing Make Copies of Completed Declaration
for Your Records
#16 - Furniture, Year
Ending
fixtures and equipment
Original cost, trans -
portation & installation %
Good Depreciated Value
10-1-15 50 95% 48 10-1-14 400 90% 360 10-1-13 380 80% 304 10-1-12 70%
10-1-11 60% 10-1-10 50% 10-1-09 40% Prior Yrs 100 30% 30 Total 930 Total 742
Example of how t
How should the following be declared?
June 2013, you bought a desk for $300 and a chair for $80. In October 2013 you buy a display rack for $400. You have a filing cabinet you bought 10 years ago for $100 that is being used in your business. A friend gave you a used bookcase, in February 2015, which you believe, is worth $50.
See the table to the right for the answer.
Assessor's Use Only
Page 2
2015 PERSONAL PROPERTY DECLARATION Commercial and financial information is not open to public inspection
List or Account #: Owner's Name: DBA:
Assessment date October 1, 2015 Required return date November 2, 2015
Location (street & number)
BUSINESS DATA For businesses, occupations, professions, farmers, lessors Answer all questions 1 through 12, writing N/A on lines that are not applicable.
1. Direct questions concerning return to - 2. Location of accounting records -
Name
Address
City/State/Zip
Phone/Fax (
3. Description of Business
4. How many employees work in your facilities in this town only?
5. Date your business began in this town?
6. How many square feet does your firm occupy at your location(s) in this town? Sq. ft. Own Lease El
7. Type of ownership: U Corporation El Partnership LLC Sole proprietor LI Other-Describe
8. Type of business: Manufacturer Wholesale LI Service Profession Li Retail/Mercantile Tradesman El Lessor
Other-Describe IRS Business Activity Code Yes No
9. In the last 12 months was any of the property included in this declaration located in another Connecticut town for at least 3 months? If yes, identify by specific months, code, cost, and location(s).
10. Are there any other business operations that are operating from your address here in this town? If yes give name and mailing address.
11. Do you own tangible personal property that is leased or consigned to others in this town? If yes, complete Lessor's Listing Report (below)
12. Did you have in your possession on October 1 st any borrowed, consigned, stored or rented property? If yes, complete Lessee's Listing Report (page 4)
LESSOR'S LISTING REPORT In order to avoid duplication of assessments related to leased personal property the following must be completed by Lessors: (Please note that property under conditional sales agreements must be reported by the lessor.) Computerized filings are acceptable as long as all Information is reoorted in prescribed format.
Lessee #1 Lessee #2 Lessee #3 Name of Lessee
Lessee's address
Physical location of equipment
Full equipment description
Is equipment self manufactured? Yes • No • Yes • No • Yes • No •
Acquisition date
Current commercial list price new
Has this lease ever been purchased, assumed or assianed?
Yes • No • Yes • No • Yes • No •
If yes, specify from whom
Date of such purchase, etc.
If original asset cost was changed by this transaction aive details Type of lease ClOperating OCapital OConditional Sale OOperating OCapital OConditional Sale DOperating CICapital OConditional Sale
Lease Term — Begin and end dates
Monthly contract rent _
Monthly maintenance costs if included in monthly payment above Is equipment declared on the Lessor's or the Lessee's manufacturing exemption application?
Yes • Yes • Yes • Lessor • Lessee • Lessor • Lessee • Lessor • Lessee • No • No • No •
Page 3
List or Account: Owner's Name:
Assessment date October 1, 2015 Required return date November 2, 2015
LESSEE'S LISTING REPORT Pursuant to Connecticut General Statutes §12-57a all leased, borrowed, consigned, loaned, rented, or stored personal property not owned by you but in your possession as of the assessment date must be included on this form. Failure to declare, in the form and manner as herein prescribed, shall result in the presumption of ownership and subsequent tax liability plus penalties. Property you do not lease that may be in your possession and must be reported includes (but is not limited to) dumpsters, gas/propane tanks, vending machines, water coolers, coffee machines. Yes No Did you dispose of any leased items that were in your possession on October 1, 2014? If
yes, enter a description of the property and the date of disposition in the space to the right.
Did you acquire any of the leased items that were in your possession on October 1,2014? El 0 If yes, indicate previous lessor, item(s) and date(s) acquired in the space to the right.
Is the cost of any of the equipment listed below declared anywhere else on this declaration? If yes, note year in the Year Included' row and list cost In the 'Accuisition Cost row.
Lease #1 Lease #2 Lease #3
Name of Lessor
Lessor's address
Phone Number
Lease Number
Item description / Model #
Serial #
Year of manufacture
Capital Lease Yes • No • Yes • No • Yes • No •
Lease Term — Beginning/End
Monthly rent
Acquisition Cost
Year Included
DISPOSAL, SALE OR TRANSFER OF PROPERTY REPORT Disposal, sale or transfer of property — If you disposed of, sold, or transferred a portion of the property included in last year's filing, complete the Detailed Listing Of Disposed Assets Report And Reconciliation Of Fixed Assets on page 6. If you no longer own the business noted on the cover sheet you do not need to complete this declaration. You must, however, return to the Assessor this declaration along with the complete AFFIDAVIT OF BUSINESS CLOSING OR MOVE OF
BUSINESS OR SALE OF BUSINESS found in this return. DO NOT INCLUDE DISPOSALS IN TAXABLE PROPERTY REPORTING SECTION.
DETAILED LISTING OF DISPOSED ASSETS COPY AND ATTACH ADDITIONAL SHEETS IF NEEDED
Date Removed Code # Description of Item Date Acquired Acquisition Cost
TAXABLE PROPERTY INFORMATION
1) All data reported should be: 2)
a) Actual acquisition costs including any additional charges for transportation and installation by year for each type of property described. These costs, less the standard depreciation as shown on the form will determine the net depreciated value. 3)
b) Include all assets that may have been fully depreciated, written off, or charged to expense but are still owned. Do not include 4) disposed assets.
Reports are to be filed on an assessment year basis of October 1. Acquisitions between October 2 and December 31 apply to the new year. (i.e. acquisition made October 30, 2014 is reported in the year ending October 1,2015). Computerized filings are acceptable as long as all information is reported in prescribed format. Do not include disposed assets. Disposals are used to reconcile last year's reporting with this year's reporting.
LI
Page 4
List or Account: Owner's Name:
Assessment date October 1, 2015 Required return date November 2, 2015
1 # 9 — Motor Vehicles garaged in Connecticut
Year
Unregistered but registered
VEHICLE 1
motor vehicles in another
VEHICLE 2
& vehicles state VEHICLE 3
Make Model VIN Length Weight Purchase $ Date
Value
#11 — Horses and
Breed
Ponies #1 #2 #3
Registered Age Sex Quality
Breeding Show Pleasure Racing
Value
CGS 12-81(76) Year
Ending ,
#13 — Manufacturing machinery for exemption -
Original cost, trans- portation & installation
% Good
& equipment must complete
Deareciat
eligible under exempt claim.
es1 Value
10-1-15 95% 10-1-14 90% 10-1-13 80% 10-1-12 70% 10-1-11 60% 10-1-10 50% 10-1-09 40% Prior Yrs 30% Total Total
#16 - Furniture,
Year Ending
fixtures and equipment
Original cost, trans- portation & installation
% Good Den reciated \table
10-1-15 95%
10-1-14 90% 10-1-13 80% 10-1-12 70% 10-1-11 60% 10-1-10 50% 10-1-09 40% Prior Yrs 30% Total
_ Total
#17 — Farm Year
Fndina
Machinery Original cost, trans-
Portation & installation %
Good Denreciated Value 10-1-15 95%
10-1-14 90%
10-1-13 80% 10-1-12 70% 10-1-11 60% 10-1-10 50%
10-1-09 40% Prior Yrs 30% Total Total
under CGS
Year Ending
#10 — Manufacturing machinery & 12-81 (76) for exemption
Original cost, trans- portation & installation
equipment
% Good
not eligible
Depreciated Value
10-1-15 95%
10-1-14 90% 10-1-13 80% 10-1-12 70% 10-1-11 60% 10-1-10 50% 10-1-09 40% Prior Yrs 30% Total Total
#12 — Commercial
Year Ending
Fishing Apparatus
Original cost, trans -
portation & installation
ok
Good Depreciated Value 10-1-15 95% 10-1-14 90% 10-1-13 80% 10-1-12 70% 10-1-11 60% 10-1-10 50% 10-1-09 4Q% Prior Yrs 30% Total Total
#14 — Mobile Manufactured real estate
Year
Homes
#1
if not currently
#2
assessed as
#3
Make Model ID Number Length Width Bedrooms Baths
Value
#18— Farm Year
Fndino
Tools Original cost, trans-
portation & installation
%
Good Deoreciated Value 10-1-15 95% 10-1-14 90% 10-1-13 80% 10-1-12 70% 10-1-11 60% 10-1-10 50% 10-1-09 40% Prior Yrs 30%
Total Total
Assessor's Use Only
#9 #10
#11 #12
#13 #14
#17 #18
Page 5
List or Account#: Owner's Name:
Assessment date October 1, 2015 Required return date November 2, 2015
#19 — Me Year
Ending
chanics Tools Original cost, trans-
portation & installation Good Dprffeciatpri Valli P
# 20 -- Electronic data processing equipment
In accordance with Section 168 IRS Codes Computers Only
#19
10-1-15 95% 10-1-14 90% Year
Ending Original cost, trans-
portation & installation Good Depreciated Value 10-1-13 80% 10-1-12 70% 10-1-15 95%
10-1-11 60% 10-1-14 80% 10-1-10 50% . 10-1-13 60% 10-1-09 40% 10-1-12 40% Prior Yrs 30% Prior Yrs 20% Total Total Total Total #20
logically with #21a
Year Ending
#21a Telecommunication company advanced —include previously
Original cost, trans- portation & installation
ok
Good
equipment not techno-coded #21c property
Deoreciatect Value
advanced—include
Year Endin
#21b Telecommunication company previously coded
Original cost, trans- ovum= & installation
equipment #21d
Good
technologically property with #21b
#21
10-1-15 95% 10-1-15 95%
10-1-14 90% 10-1-14 80% 10-1-13 80% 10-1-13 60% 10-1-12 70% 10-1-12 40% 10-1-11 60% Prior Yrs 20% 10-1-10 50% Total Total 10-1-09 40%
21a and 21b Total Prior Yrs 30% Total Total
#22 — Cables, Year
Ending
conduits, pipes, Original cost, trans-
portation & installation
etc %
Good Deoreciated_Value
#23 - Expensed Supplies
The average is the total amount expended on supplies since October 1, 2014 divided by the number of months in business since October 1, 2014.
#22
10-1-15 10-1-14 Year
Ending Total Expended # of
Months Average Monthly
10-1-13 10-1-12 10-1-15 10-1-11 10-1-10 10-1-09 Prior Yrs
Total Total Check here if a DPUC regulated utility] #23
#24a — Other
Year Ending
Goods - includin
Original cost, trans- potation & installation
g leaseh
Good
old improvements
nenfPriated Value
#24b -- Rental
Year Ending 10-1-15
Entertainment Medium
Original cost, trans- portatIon & installation Good Ilanraciated Value
#24
10-1-15 95% 95% 10-1-14 90% 10-1-14 80% 10-1-13 80% 10-1-13 60% 10-1-12 70% 10-1-12 40% 10-1-11 60% Prior Yrs 20% 10-1-10 50% Total Total 10-1-09 40% # of video tapes
# of music CD's
24a and 24b
# of DVD movies
# of video games Prior Yrs 30%
Total Total Total
RECONCILIATION OF FIXED ASSETS
*Complete Detailed Listing of Disposed Assets —page 4
Assets declared 10/1/14 * Assets disposed since 10/1/14
Assets added since 10/1/14 Assets declared 10/1/15
Expensed equipment last year Capitalization Threshold
Page 6
2015 PERSONAL PROPERTY DECLARATION — SUMMARY SHEET Commercial and financial information is not open to public inspection.
List or Account#:
Owner's Name:
DBA:
Assessment date October 1, 2015 Required return date November 2, 2015
This Personal Property Declaration must be signed and delivered or postmarked by
Monday, November 2, 2015 to Assessor of Town
where property is located
Mailing address:
Cit /State/Zi :
Location (street & number) Net Depreciated Value pages 5 & 6
ASSESSOR'S USE ONLY
Property Code and Description Code ASSESSMENTS
#9 Motor Vehicles UNREGISTERED motor vehicles (e.g. campers, RV's, snowmobiles, trailers, trucks, passenger cars, tractors, off-road construction vehicles, etc.) including any vehicle garaged in Connecticut but registered in another state, or any such vehicle not registered at all. If you are a farmer eligible for the exemption under Sec. 12-91, list tractors in Code 17. #9
#10 - Machinery & Equipment Industrial manufacturing machinery and equipment (e.g., tools, dies, jigs, patterns, etc.). Include air and water pollution contra! equipment. #10
#11 Horses And Ponies Describe your horses and ponies. A $1,000 assessment exemption per animal will be applied. If you are a farmer, the exemption may be 100% provided Form M-28 is filed with and approved by the Assessor. #11
#12 - Commercial Fishing Apparatus All fishing apparatus exclusively used by a commercial fisherman in his business (e.g., fishing poles, nets, lobster pots, fish finders, etc.). A $500 value exemption will be applied. #12
#13 —Manufacturing machinery & equipment Manufacturing machinery and equipment used in manufacturing; used in research or engineering devoted to manufacturing; or used for the significant servicing or overhauling of industrial machinery or factory products and eligible for exemption under CGS 12-81 (76), (Formerly property Codes 13 & 15) #13
#14 Mobile Manufactured Homes if not currently assessed as real estate #14 #16 - Furniture & Fixtures Furniture, fixtures and equipment of all commercial, industrial, manufacturing, mercantile, trading and all other businesses, occupations and professions. Examples: desks, chairs, tables, file cabinets, typewriters, calculators, copy machines, telephones (including mobile telephones), telephone answering machines, facsimile machines, postage meters, cash registers, moveable air conditioners, partitions, shelving display racks, refrigerators, freezers, kitchen equipment, etc. #16 #17 - Farm Machinery Farm machinery (e.g., tractors, harrows, bush hogs, hay bines, hay rakes, balers, corn choppers, milking machines, milk tanks, coolers, chuck wagons, dozers, back hoes, hydroponic farm equipment, aquaculture equipment, etc.), used in the operation of a farm, #17
#18 - Farming Tools Farm tools, (e.g., hoes, rakes, pitch forks, shovels, hoses, brooms, etc.). #18
#19 - Mechanics Tools Mechanics tools (e.g., wrenches, air hammers, jacks, sockets, etc.). #19
#20 - Electronic Data Processing Equipment Electronic data processing equipment (e.g., computers, printers, peripheral computer equipment, and any computer based equipment acting as a computer as defined under Section 168 of the IRS Code of 1988, etc.). Bundled software is taxable and must be included. #20
#21 - Telecommunications Equipment Excluding furniture, fixtures, and computers, #21a includes cables, conduits, antennae, batteries, generators or any equipment not deemed technologically advanced by the Assessor. #21b includes controllers, control frames, relays switching and processing equipment or other equipment deemed technologically advanced by the Assessor. #21
#22 - Cables, conduits, pipes, poles, towers (if not currently assessed as real estate), underground mains, wires, turbines, etc., of gas, heating, or energy producing companies, telephone companies, water and water power companies. Include items annexed to the ground (e.g., hydraulic car lifts, gasoline holding tanks, pumps, truck scales, etc.), as well as property used for the purpose of creating or furnishing a supply of water (e.g., pumping stations). #22
#23 - Expensed Supplies The average monthly quantity of supplies normally consumed in the course of business (e.g., stationery, post-it notes, toner, computer disks, computer paper, pens, pencils, rulers, staplers, paper clips, medical and dental supplies and maintenance supplies. etc.), #23
#24 — Other All Other Goods, Chattels and Effects Any other taxable personal property not previously mentioned or which does not appear to fit into any of the other categories. (e.g. video tapes, vending machines, pinball games, video games, signs, billboards, coffee makers, water coolers, leasehold Improvements. #24
Total Assessment — all codes #9 through #24 Subtotal > #25 — Penalty for failure to file as required by statute — 25% of assessment
#25 Exemption - Check box adjacent to the exemption you are claiming:
ID I — Mechanic's Tools - $500 value 11 PA - Commercial Fishing Apparatus - $500 value
ID I — Farming Tools - $500 value • I — Horses/ponies $1000 assessment per animal All of the following exemptions require a separate application and/or certificate to be filed with the Assessor by the required return date
12J - Water Pollution or Air Pollution control equipment —Connecticut DEEP certificate required — provide copy
P I - Farm Machinery $100,000 assessment - Exemption application M-28 required annually
FT G & H — Distressed Municipality/Enterprise Zone/Enterprise Corridor Zone - Exemption application M-55 required annually
DLL— Manufacturing Machinery & Equipment - Exemption claim required annually
Total Net Assessment Assessor's Final Assessment Total >
Page 7
Dated Signature
Signature/Title
Print or type name
Section A OWNER I DO HEREBY declare under penalty of false statement that all sections of this declaration have been completed according to the best of my knowledge, remembrance, and belief; that it is a true statement of all my personal property liable to taxation; and that I have not conveyed or temporarily disposed of any estate for the purpose of evading the laws relating to the assessment and collection of taxes as per Connecticut General Statutes §12-49.
SEE PAGE TWO (2) FOR SIGNATURE REQUIREMENTS. CHECK ONE 0 OWNER El PARTNER
El CORPORATE OFFICER 11 MEMBER
Section B AGENT I DO HEREBY declare under oath that I have been duly appointed agent for the owner of the property listed herein and that I have full authority and knowledge sufficient to file a proper declaration for him in accord with the provisions of §12-50 C.G.S.
Agent's Signature
Agent's Signature /Title
Print or type agent's name
AGENT SIGNATURE MUST BE WITNESSED Witness of agent's sworn statement
Subscribed and sworn to before me -
Circle one: Assessor or staff member, Town Clerk, Justice of the Peace, Notary or Commissioner of Superior Court
Dated
Dated
List or Account#: Owner's Name:
Assessment date October 1, 2015 Required return date November 2, 2015
DECLARATION OF PERSONAL PROPERTY AFFIDAVIT THIS FORM MUST BE SIGNED (AND IN SOME CASES WITNESSED) BEFORE IT MAY BE FILED WITH THE ASSESSOR.
AVOID PENALTY — IMPROPERLY SIGNED DECLARATIONS REQUIRE A 25% PENALTY COMPLETE SECTION A OR SECTION B
Direct questions concerning declaration to the Assessor's Office
where property is located.
Notes:
Check Off List: 111 Read instructions on page 2 E Complete appropriate sections 0 Complete exemption applications
111Sign & date as required on page 8 El Make a copy for your records
O Return by November 2, 2015
This Personal Property Declaration must be signed above and delivered to the Assessor or postmarked (as defined in C.G.S. Sec 1-2a & as referenced in Sec. 12-41(d)) by Monday, November 2, 2015
— a 25% Penalty required for failure to file as required.
Page 8
PART III: DECLARATION OF PROPERTY BELONGING TO OTHERS - IF NONE WRITE "NONE"
11, 9. Lessor's name Mailing address
Tax Obligation: A. Lessor B. Lessee
PART I: GENERAL INFORMATION COMPLETE (a) THRU (g) ASSESSOR'S USE ONLY
a. Enter type of business:
b. Enter local telephone number ( ) FAX number ( ) E-Mail Address
c. Do you own the land at this business location? p YES 1=1 NO If yes, is the name on your deed recorded as shown on this statement? 1=1 YES p NO
d. When did you start business at this location? DATE - If your business name or location has changed from last year, enter the former name and/or location:
e. Enter location of general ledger and all related accounting records (include zip code):
f. Enter name and telephone number of authorized person to contact at location of accounting records:
DECLARATION OF PROPERTY BELONGING TO YOU (attach schedule for any adjustment to cost)
COST (omit cents)
(see instructions)
ASSESSOR'S USE ONLY
FULL CASH VALUE
1. Supplies
2. Equipment
3. Equipment out on lease, rent, or conditional sale to others
4. Bldgs., Up. Impr., and/or Leasehold lmpr., Land Impr, Land
5. Construction in Progress
6. Alternate Schedule A
7.
8.
0
0
TOTAL F.C.V.
I
j LESS FIXTURES
L PERSONAL PROP.
1
1. Leased equipment 2. Lease-purchase option equipment 3. Capitalized leased equipment
4. Vending equipment 5. Other businesses 6. Government-owned property
Year Year Description of of and Lease or
Acq. Mfr. Identification Number
Annual Rent
Report conditional sales contracts that are not leases on Schedule A
(SPECIFY TYPE BY CODE NUMBER) Cost to Purchase
New
OWNERSHIP TYPE (,/)
Proprietorship
Partnership 0
Corporation 0
Other _ _ 0
Note: The following declaration must be completed and signed. If you do not do so, It may result In penalties. I declare under penalty of perjury under the laws of the State of California that! have examined this property statement, including accompanying schedules, statements or other attachments, and to the best of my knowledge and belief it Is true, correct, and complete and includes all property required to be reported which is owned, claimed, possessed, controlled, or managed by the person named as the assessee in this statement at 12:01 am, on January 1, 2016.
SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT' DATE
BUSINESS NAME OF ASSESSEE OR AUTHORIZED AGENT (typed or printed)
DESCRIPTION („/) TITLE
RETAIN
ASSESSED FLAG
TREND
OVERRIDE
INACTIVE
DELETE
A/C
LEGEND
BILL#
FOR
ESCAPE ASSM'T
TYPE
CODE
ADD INTEREST
AFTER
APPLY 10% PEN
AE
DEPUTY
DATE
APPROVAL
g. During the period of January 1, 2016 through December 31, 2016:
(1) Did any individual or legal entity (corporation, partnership, limited liability company, etc.) acquire a "controlling interest" (see instructions for definition) in this business entity? Ei YES p NO
(2) If YES, did this business entity also own "real property" (see instructions for definition) in California at the time of the acquisition?
El YES El NO
(3) If YES to both questions (1) and (2), filer must submit form BOE-100-B, Statement of Change in Control and Ownership of Legal Entities, to the State Board of Equalization. See instructions for filing requirements.
PART II:
(FrOm line 38)
(Attach Schedule)
(From line 63)
(Attach Schedule)
(See instructions)
ASSESSOFI'S USE ONLY
JAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address.)
ASSESSOR'S USE ONLY TAX RATE
AREA ASSESSOR'S IDENTIFICATION NUMBER
MAP BOOK PAGE PARCEL
LOCATION OF THE BUSINESS PROPERTY (File a separate statement for each location.)
RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED.
N 0
Acq. COST
ASSESSOR'S USE ONLY
/ COST
ASSESSOR'S USE ONLY
/
Acq. COST
ASSESSOR'S USE ONLY
/
Acq. COST
ASSESSOR'S USE ONLY
11 2015 ni5 2015
12 2014 nia 2014
13 2013 N13 2013
14 2012 2012 2012
15 2011 2011 2011
• 2010 N10 2010
17 nos 2009 2009
18 2008 nos 2008
• 2007 2007 2007
• 2006 2••• Prior
21 2005 2005 Total
22 2004 no4 Calen-
dar Year
of Acq.
LOCAL AREA NETWORK (LAN) EQUIPMENT AND MAINFRAMES
23 2003 2003
24 2002 Prior
25 2II Total 0 COST ASSESSOR'S USE ONLY • NO0
Year ot
cl
dar 0 TOOLS, MOLDS, DIES, JIGS is 1
28
1999 COST
ASSESSOR'S USE ONLY
/
2015
1998 2014 • 2015 2013
30 1996 2014 2012
31 1995 2013 2011
32 1994 2012 2010 33 1993 2011 2009
34 1992 2010 2008
35 1991 2009 2007
• • Prior Prior
37 Total o o Total 0 Total 0
38 Add TOTALS on lines 21, 25, 37 and any additional schedules. ENTER HERE AND ON PART II, LINE 2
. 0
SCHEDULE
B
COST DETAIL: BUILDINGS, BUILDING IMPROVEMENTS, AND/OR LEASEHOLD IMPROVEMENTS, LAND IMPROVEMENTS, LAND AND LAND DEVELOPMENT Attach schedules as needed. Line 61 "Prior"- Report detail by year(s) of acquisition on a separate schedule.
2016
L I N E
N 0
Calen- dar
Year of
Acq.
BUILDINGS, BUILDING IMPROVEMENTS, AND/OR LEASEHOLD IMPROVEMENTS
0) LAND IMPROVEMENTS
(e.g., blacktop, curbs, fences)
LAND AND LAND DEVELOPMENT (e.g., (ii, grading) 0 STRUCTURE ITEMS ONLY
('-.ge ins/ructions) Ci.) F1%1105, 1 ONLY
COST ASSESSOR'S USE ONLY
COST ASSESSOR'S
USE ONLY
/ COST ASSESSOR'S
USE ONLY COST ASSESSOR'S
USE ONLY 39 2015
40 2014
41 2013
42 2012
43 2011
44 2010
45 2009
46 2008
47 2007
48 2006
49 2005
50 2004
51 2003
52 2002
53 2001
54 2000
88 1999
56 1998
57 1997
58 1996
59 1995
60 1994
61 Prior
62 Total 0 0 0 0
JANUARY 1, 2016 For Assessor's Use Only
PRIVACY NOTICE: The records in this series are confidential according to IC 6-1.1-35-9.
FORM 103- LONG
BUSINESS TANGIBLE PERSONAL PROPERTY ASSESSMENT RETURN State Form 11405 (R37 / 10-15)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: • Please type or print. • This form must be filed with the Township Assessor. if any or the County Assessor of the county in which the property
is located not later than Monday, May 16, 2016, unless an extension of up to thirty (30) days is granted in writing. Contact information for the Assessor is available at http://www.in.goy/dIgf/2440.htm.
• A Form 104 must be filed with the return.
NOTE: For taxpayers with less than $20,000 cost to report within the county, legislation was passed in 2015 which exempts this property. For more information, refer to the "Filing Basics" section on page four of this form.
Name of taxpayer Federal identification number**
Name under which business is conducted DLGF taxing district number
Address where property is located (number and street, city, state, and ZIP code) DLGF taxing district name
Nature of business NAICS • - Code number Township
Name and address to which Assessment and Tax Notice are to be mailed Of different than above) County
Retail merchants certification number
1. Federal income tax year ends Name filed under
2. Location of accounting records
3. Form of business • Partnership or Joint Venture • Sole Proprietorship • Corporation • Estate or Trust
• Other, describe: 4. Do you have other locations in Indiana? • Yes • No 5. Did you own, hold, possess or control any leased, rented or other depreciable personal property on January 1? • Yes • No (See 50 IAC 4.2-8)
6. Did you own, hold, possess or control any Special Tools on January 1? • Yes • No (See 50 IAC 4.2-6-2)
7. Did you own, hold, possess or control any returnable containers on January 1? • Yes • No (See 50 IAC 4.2-6-4)
If taxpayer answers "yes" to question 5, the owner must file Form 103-0 and the possessor must file Form 103-N. Failure to properly disclose lease information may result in a double assessment. (See 50 IAC 4.2-2 and 50 IAC 4.2-8).
Failure to file a return on or before the due date as required by law will result in the imposition of a twenty-five dollar ($25) penalty. In addition, if the return is not filed within thirty (30) days after such return is due, a penalty equal to twenty percent (20%) of the taxes finally determined to be due with respect to the property which should have been reported will be imposed. A personal property return is not due until the expiration of any extension period granted by the Township Assessor or County Assessor under IC 6-1.1-3-7(b). If the total assessed value that a person reports on a personal property return is less than the total assessed value that the person is required by law to report and if the amount of the undervaluation exceeds five percent (5%) of the value that should have been reported on the return, then the County Auditor shall add a penalty of twenty percent (20%) of the additional taxes finally determined to be due as a result of the undervaluation.
In completing a personal property return for a year, a taxpayer must make a complete disclosure of all information relating to the value, nature, or location of personal property owned, held, possessed or controlled on the assessment date. (IC 6-1.1-3-9(a)). This information would include, but not be limited to, completion of the heading and related information, answers to all questions on the face of the return, and entries on all of the appropriate lines of Schedule A. If such information is not provided, the taxpayer will be contacted and directed to provide that information. In addition, a penalty of $25 shall be imposed. (IC 6-1.1-37-7(d))
* NAICS - North American Industry Classification System - A complete list of codes may be found at www.census.gov . The Indiana Code (IC) and Indiana Administrative Code (IAC) may be found on-line at the DLGF website - www.in.gov/dIgf. For further questions, contact the County Assessor (available on the DLGF website).
NOTE: The NAICS Code Number appears on your federal income tax return.
** An individual using his Social Security Number as the Federal Identification Number is only required to provide the last four digits of that number. IC 4-1-10-3.
SUMMARY (Round all numbers to nearest ten dollars) REPORTED BY TAXPAYER CHANGE BY ASSESSOR CHANGE BY THE COUNTY BOARD
Schedule A- Personal Property + $
Deduction per Form 103 ERA or Form 103-CTP • $ $ $
Final Assessed Valuation =
Under penalties of perjury, I hereby certify that this return knowledge and belief, is true, correct, and complete; reports the named taxpayer, in the stated taxing district, on the amended, and regulations promulgated with respect thereto.
$
SIGNATURE AND VERIFICATION (including accompanying all tangible personal
assessment date, as required
$
schedules, deduction claims and property subject to taxation, owned,
by law; and is prepared in accordance
$
statements), to the best of my held, possessed or controlled by
with IC 6-1.1 of seq., as
Signature of authorized person Telephone number
( )
Date (month, day, year)
Name and title of authorized person (please type or print) E-mail contact
Signature of person preparing return, if different than authorized person Name and contact information of preparer (please type or print)
Page 1 of 4
FORM See 50
Line
103 - LONG IAC 4.2-4
Report all personal
TANGIBLE
property assessable to this taxpayer
PERSONAL PROPERTY CONFIDENTIAL
figures below to nearest dollar)
SCHEDULE A JANUARY 1, 2016
Federal Identification Number below. (Round all
1 Total cost of tangible depreciable personal property. (50 IAC 4.2-4-2) $
2 Adjustment to federal tax basis per Form 106. (50 IAC 4.2-4-4)
3 Total cost and base year value of tangible depreciable personal property. (Line 1 plus 2) $
Deduct Exempt Property (See 50 IAC 4.2- 11.1) COST
4 Stationary industrial air purification systems. (Attach Form 103-P)
5 Industrial waste control facilities. (Attach Form 103-P)
6 Enterprise information technology equipment. (Attach Form 103-IT)
7 Vehicles / airplanes subject to excise tax.
[Number of Units $
Total cost of exempt property (Deduct from Line 3 and enter on L ne El)
8 I Subtotal $
Additions: See 50 IAD 4.2-1-1.1 and 50 IAC 4.2-4-3(b) and 4
$ 9 Cost of all depreciable personal property still in use but written off. (50 IAC 4.2-4-3(b))
10 Cost of installation and foundations applicable to depreciable personal property. (50 IAC 4.2-4-2(d))
11 Cost of interest incurred during construction and installation applicable to depreciable personal property. (50 IAC 4.2-4-3(j))
12
(From Schedule POOLING
Total cost and base (add Lines 8, 9,
SUMMARY A-1 or Form 103-P5)
year 10 and 11.
value of assessable depreciable Line 12 must agree with
TOTAL COST COLUMN A
$
personal property. Line 52 Column A)
ADJUSTMENTS COLUMN B
ADJUSTED COST COLUMN C
$
TRUE TAX VALUE COLUMN D
52 Total All Pools
53 30% of Adjusted Cost (Line 52, Column C) (enter zero (0) if filing 103-P5 and entity is a qualified steel mill or oil refinery per IC 6-1.1-3-23). $
54 Greater of Lines 52D or 53. $
Adjustments to True Tax Value
55 Cost Equipment not placed in service and/or critical Cos
spare parts (50 IAC 4.2-6-1 & 6) per Form 106, $ X 100/
$
56 Tools, dies, jigs, fixtures, etc., per Form 103-T. (50 /AC 4.2-6-2) Cost
$ $
57 Permanently retired equipment (50 IAC 4.2-4-3) and/or returnable containers (50 IAC 4.2-6-4) per Form 106.
Cost $ $
58 Commercial aircraft and commercial bus line fleet, not subject to excise tax per Form 103-1. (50 !AC 4.2-10)
Cost $ $
59 Total additions to True Tax Value. (Lines 55, 56, 57 and 58) $
60 Total True Tax Value before adjustments for "Abnormal Obsolescence." (Line 54 plus Line 59) $
61 Abnormal Obsolescence Adjustment per Form 106. (50 IAC 4.2-4-8) $
62 Total True Tax Value of personal property. (To page 1, Form 103 Summary) $
Page 2 of 4
FORM 103- LONG
TANGIBLE PERSONAL PROPERTY
SCHEDULE A See 50 IAC 4.2-4
CONFIDENTIAL
JANUARY 1, 2016
* * The total cost of special tools, dies, jigs, fixtures, etc., permanently retired equipment; commercial aircraft, and commercial bus line fleet, not subject to excise tax is to be deducted in full in Column B below. The true tax value of such property is to be computed on the proper Form(s) (103-T, 106 AND 103-1, respectively) and recorded on LIne(s) 56, 57 and 58.
ROUND ALL FIGURES BELOW TO THE NEAREST DOLLAR.
YEAR OF ACQUISITION I COLUMN A COLUMN B COLUMN C COLUMN D
POOL NUMBER 1: (1 TO 4 YEAR LIFE)
TOTAL COST OR BASE YEAR VALUE
ADJUSTMENTS ** (See Note Above) ADJUSTED COST T.T.V.% TRUE TAX VALUE
13 3-2-15 To 1-1-16 65
14 3-2-14 To 3-1-15 50
15 3-2-13 To 3-1-14 35
16 Prior To 3-2-13 $ $ 20 $
17 TOTAL POOL NUMBER 1
POOL NUMBER 2: (5 TO 8 YEAR LIFE) 18 3-2-15 To 1 -1-16 40
19 3-2-14 To 3-1-15 56
20 3-2-13 To 3-1-14 42
21 3-2-12 To 3-1-13 32
22 3-2-11 To 3-1-12 24
23 3-2-10 To 3-1-11 18
24 Prior To 3-2-10 $ $ $ 15 $
25 TOTAL POOL NUMBER 2
POOL NUMBER 3: (9 TO 12 YEAR LIFE) 26 3-2-15 To 1-1-16 40
27 3-2-14 To 3-1-15 60
28 3-2-13 To 3-1-14 55
29 3-2-12 To 3-1-13 45
30 3-2-11 To 3-1-12 37
31 3-2-10 To 3-1-11 30
32 3-2-09 To 3-1-10 25
33 3-2-08 To 3-1-09 20
34 3-2-07 To 3-1-08 16
35 3-2-06 To 3-1-07 12
36 Prior To 3-2-06 $ $ $ 10 $
37 TOTAL POOL NUMBER 3
38 3-2-15 To 1-1-16 POOL NUMBER 4: (13 YEAR AND LONGER LIFE)
40
39 3-2-14 To 3-1-15 60
40 3-2-13 To 3-1-14 63
41 3-2-12 To 3-1-13 54
42 3-2-11 To 3-1-12 46
43 3-2-10 To 3-1-11 40
44 3-2-09 To 3-1-10 34
45 3-2-08 To 3-1-09 29
46 3-2-07 To 3-1-08 25
47 3-2-06 To 3-1-07 21
48 3-2-05 To 3-1-06 15
49 3-2-04 To 3-1-05 10
50 Prior To 3-2-04 $ $ $ 5 $
51 TOTAL POOL NUMBER 4 52
TOTAL ALL POOLS
NOTE: All Column B adjustments above must be supported on Form 106, Form 103-T, or Form 103-1.
Page 3 of 4
Filing Basics:
• Effective July 1, 2015, IC 6-1.1-3-7.2 was amended to allow an exemption for taxpayers with less than $20,000 cost to be reported within a county. Taxpayers may not be required to file a personal property return; however, the statute does require them to file a notarized certification annually. Failure to timely file this certification will result in a $25 penalty. For more information, refer to this link: http://www.in.gov/dIgf/7576.htm.
• Taxpayers may request up to a thirty (30) day extension of time to file their return. The written request should be sent to the Assessor before the filing deadline of Monday, May 16, 2016, and should include a reason for the request. The Assessor may, at their discretion, approve or deny the request in writing.
• Personal property must be assessed in each taxing district where property has a tax situs.
• Inventory located in the State of Indiana is exempt and is not required to be reported per IC 6-1.1-1-11(b)(3).
• It is the responsibility of the taxpayer to obtain forms from the Assessor and file a timely return. The forms are also available on-line at the Indiana Department of Local Government Finance's website at wvvw.in.gov/dIgf.
• If you hold, possess, or control not-owned personal property on the assessment date, you have a liability for the taxes imposed for that year unless you establish that the property is to be assessed to the owner. This is done by completing a Form 103-N, attaching it to the Form 103-Long, and filing it with the Assessor. NOTE: Failure to properly disclose lease information may result in a double assessment. (IC 6-1.1-2-4(a))
• Taxpayers who discover an error was made on their original timely filed personal property tax return have the right to file an amended return. The amended return must be filed within twelve (12) months of the due date or the extended due date (if up to a thirty (30) day extension was granted) of their original return.
Frequently Asked Questions: A. How do I find out my Taxing District Name and Number?
You will need to contact your County Assessor for assistance since heavily populated areas can have several taxing districts within a single township.
B. How do I find out my NAICS number? This six-digit code number appears on the federal returns filed for businesses. For a complete list of the codes, go to www.census.gov.
C. Will my local Assessor fill this form out for me? Indiana's personal property tax system is a self-assessment system. An Assessor can offer assistance with the filing; however, an authorized person representing the business must sign the form under penalties of perjury that it is true and correct so the responsibility of filing an accurate return remains with the taxpayer.
D. How can I find contact information for the various county offices (Assessor, Auditor, or Treasurer) throughout the State of Indiana, locate forms or learn more about Indiana's personal property tax system? Go to the Indiana Department of Local Government Finance's website at www.in.gov/dIgf. Contact information for the Assessor is available at http://www.in.gov/dIgf/2440.htm.
INFORMATION OF NOT-OWNED PERSONAL PROPERTY WHICH IS TO BE ASSESSED TO THE OWNER NOTE: This form is for the reporting of two or less Operating Leases. For all other leases, the Form 103-N (for the lessee) and the Form 103-0 (for the lessor) should be utilized. For more information on the reporting of leased equipment, refer to 50 IAC 4.2-8. Failure to properly disclose lease information may result in a double assessment.
Name and Address of the Owner
Location of Property
Date of Lease (month, day, year)
Model Number and Description Quantity Cost,
if Known
Page 4 of 4
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