Sprague, Connecticut 2015 Declaration of Personal Property – Short

Town of Sprague
Assessor’s Office
P.O. Box 162
Baltic, CT 06330-0162
Return Service Requested
TO:
Sprague, Connecticut
2015 Declaration of Personal Property – Short Form
Who Should File : All owners of taxable personal property. If you no
longer own the above noted business or personal property assessed in
your name last year, you need only to complete the AFFIDAVIT OF
BUSINESS CLOSING OR MOVE OF BUSINESS OR SALE OF BUSINESS below and
return this declaration to the Assessor. If you do not, the Assessor must
assume that you are still operating the business or still own and have
failed to declare your taxable personal property.
Complete: Complete the entire declaration. Writing “Same as last year”
is not acceptable. Do not forget the DETAILED LISTING OF DISPOSED
ASSETS REPORT (page 2) and the LESSEE’S LISTING REPORT (page 4).
Signature Required: The owners shall sign the DECLARATION OF
PERSONAL PROPERTY AFFIDAVIT (page 4). The owner’s agent may sign the
declaration, in which case the declaration must be duly sworn to or
notarized.
Extension: The Assessor may grant a filing extension for good cause
(CGS §12-42). If a request for an extension is needed, you need to
contact the Assessor in writing by November 1 (or the Monday following if
November 1 falls on Saturday or Sunday)
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) no later than:
Monday, November 2, 2015
Sprague Assessor is in the office on Thursdays from 9 - 4.
Declarations may be dropped off during any town hall hours.
The Town of Sprague consists of three villages: Baltic, Hanover, and Versailles..
Direct questions concerning declaration to the Assessor’s Office at:
Phone 860– 822-3000 Ext 222
Fax 860– 822-3016
Hand deliver declaration to:
Mail declaration to:
Town of Sprague
Town of Sprague
Assessor’s Office
Assessor’s Office
1 Main St.
P.O. Box 162
Baltic, CT
Baltic, CT 06330-0162
Check Off List:
 Read instructions
 Complete appropriate sections
 Complete exemption applications
 Complete disposed asset report
 Corporations complete all of page 3
 Make a copy for your records
 Sign, date & witness as required on page 4
 Return by November 2, 2015
AFFIDAVIT OF BUSINESS TERMINATION OR MOVE OR SALE OF BUSINESS OR PROPERTY
I
of
Business or property owners name
at
Business Name (if applicable)
With regards to said business or property I do so certify that on
Street location
Said business or property was (indicate which one by circling):
Date
SOLD TO:
Name
Address
City/Town and State to where business or property was moved
Address
MOVED TO:
TERMINATED:
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
This form may NOT be used by utility companies, telecommunication companies, lessors,
or persons claiming manufacturing machinery and equipment (Codes 10 or 13)
2015 PERSONAL PROPERTY DECLARATION – SHORT FORM
Commercial and financial information is not open to public inspection.
TAXABLE PROPERTY INFORMATION Give actual acquisition costs including any additional
charges for transportation and installation by year for each type of property described.
Circle
One
Year
Ending
#12 – Commercial Fishing Apparatus
#17 – Farm machinery
Original cost, transportation & installation
10-1-15
10-1-14
10-1-13
10-1-12
10-1-11
10-1-10
10-1-09
%
Good
or
95%
90%
80%
70%
60%
50%
40%
30%
Total
Prior Yrs
Total
Year
Ending
Original cost, transportation & installation
10-1-15
10-1-14
10-1-13
10-1-12
10-1-11
10-1-10
10-1-09
%
Good
Total
Original cost, transportation & installation
%
Good
Depreciated Value
95%
90%
80%
70%
60%
50%
40%
30%
Total
Prior Yrs
Total
#12
#17
#18
#19
# 20 -- Electronic data processing equipment
Depreciated Value
95%
90%
80%
70%
60%
50%
40%
30%
Total
Prior Yrs
Year
Ending
10-1-15
10-1-14
10-1-13
10-1-12
10-1-11
10-1-10
10-1-09
#16 – Furniture, fixtures and equipment
Assessor’s
Use Only
#18 – Farm Tools
or
#19 – Mechanics Tools
Circle
One
Depreciated Value
COPY AND ATTACH ADDITIONAL SHEETS IF NEEDED
Year
Ending
Original cost, transportation & installation
10-1-15
10-1-14
10-1-13
10-1-12
%
Good
Depreciated Value
95%
80%
60%
40%
20%
Total
Prior Yrs
Total
In accordance with Section 168 IRS Codes
Computers Only
Year
Ending
# of
Mo.s
# 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
10-1-15
#24a – Other Goods - including leasehold improvements
#24b -- Rental Entertainment Medium
Year
%
Original cost, transEnding portation & installation Good
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
Year
Ending
10-1-15
10-1-14
10-1-13
10-1-12
Depreciated Value
Total Expended
#16
#20
Average Monthly
#23
Original cost, transportation & installation
Prior Yrs
Total
%
Good
95%
80%
60%
40%
20%
Total
Depreciated Value
# of video tapes
# of DVD movies
# of music CD’s
# of video games
24a and 24b Total
#24
Detailed Listing of Disposed Assets Report– If you disposed of, sold, or transferred a portion of the property included in last year’s filing,
complete the following. DO NOT INCLUDE DISPOSALS IN TAXABLE PROPERTY INFORMATION
Date Removed
Code #
Description of Item
Date Acquired
Acquisition Cost
Page 2
2015 PERSONAL PROPERTY DECLARATION – SHORT FORM SUMMARY SHEET
Commercial and financial information is not open to public inspection
Assessment date October 1, 2015
Required return date November 2, 2015
List or Account #
Owner’s Name
DBA
Address
City/State/Zip
/
Phone / Fax
Street location of personal property in Sprague
E-mail
Description of business:
Type of ownership:  Corporation  Partnership  LLC  Sole Proprietor  Other-Describe
Type of business:  Manufacturer  Wholesale  Service  Profession  Retail/Mercantile  Tradesman  Other
IRS Business Activity Code
Square footage
No. of Employees
ASSESSOR’S
USE ONLY
#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.
Year
Make
Model
Identification No.
Length
Weight
Purchase
Price
Date
Value
Code
ASSESSMENTS
#9
#9
#9
#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.
Breed
Age
Registered
Sex
Quality:
Breeding/Show/Pleasure/Racing
Value
#11
#11
#11
#14 Mobile Manufactured Homes if not currently assessed as real estate
Year
Make
Model
Identification No.
Length
Width
Bedrooms
Baths
Value
#14
Net Depreciated
Value From page 2
Property Code and Description
#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
#16 - Furniture & Fixtures Furniture, fixtures and equipment of all commercial, industrial, manufacturing, mercantile, trading
and all other businesses, occupation 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 1986, etc.). Bundled software is taxable and must be included.
#20
#23 - Average 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 (other than realty etc.).
Total Assessment – all codes #9 through #24
#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:
 I – Mechanic’s Tools - $500 value M – Commercial Fishing Apparatus - $500 value
 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
 J – Water Pollution or Air Pollution control equipment – Connecticut DEP certificate required – provide copy
 I – Farm Machinery $100,000 assessment - Exemption application M-28 required annually
 G & H – Distressed Municipality/Enterprise Zone/Enterprise Corridor Zone - Exemption application M-55 required annually
Total Net Assessment
Assessor’s Final Assessment Total >
Page 3
LESSEE’S LISTING REPORT Lessee’s Name ________________________________________ Pursuant to Connecticut General Statutes §1257a 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.
COPY AND ATTACH ADDITIONAL SHEETS IF NEEDED
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? 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 ‘Acquisition Cost’ row.
Lease #1
Lease #2
Lease #3
Yes  No 
Yes  No 
Yes  No 
Name of Lessor
Lessor’s address
Lease Number
Item description / Model #
Serial #
Year of manufacture
Capital Lease
Lease Term – Beginning/End
Monthly rent
Acquisition Cost
Year Included
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
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.
CHECK ONE


OWNER
CORPORATE OFFICER


PARTNER
MEMBER
Signature
Dated
Signature/Title
Print or type name
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
Dated
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 -
Dated
Circle one: Assessor or staff member, Town Clerk, Justice of the Peace, Notary or Commissioner of Superior
Court
The Personal Property Declaration must be signed above and delivered to the Sprague Assessor or postmarked (as defined in
C.G.S. Sec. 1-2a) by Monday, November 2, 2015 – a 25% Penalty required for failure to file as required.
Page 4