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343 <br />SCHEDULED I SEPARATELY SCHEDULED PROPERTY <br />1. Does your business own any artwork, displays, statues, or other personal property that is separately <br />scheduled for Insurance purposes? YES • NO <br />Please describe the items and estimated value of items if applicable. <br />SCHEDULE E FARM EQUIPMENT <br />Does your business own any tractors and /or other farm equipment? .. YES ! NO Cost on Schedule A <br />If so, list and attach separate schedule. If listed by cost on Schedule A, indicate above but still include information on separate schedule. <br />SCHEDULE F I INTANGIBLE PERSONAL PROPERTY <br />Do you lease or rent real property from exempt owners, such as a church, local, state, or federal government, an airport authority, university, or other <br />exempt owner? YES ` NO If yes, include lease information below. Attach additional schedule if necessary. <br />NAME AND ADDRESS OF OWNER <br />DESCRIPTION OF PROPERTY <br />AND LEASE T M <br />MONTHLY PAYMENT <br />ACCT. # <br />SCHEDULE G I ACQUISITIONS AND DISPOSALS DETAIL <br />Acquisitions and disposals detail of machinery, equipment, furniture and fixtures and computer equipment, and leasehold improvements in the prior <br />year. If there is not enough room below, attach separate schedule. <br />ACQUISITIONS - ITEMIZE IN DETAIL <br />100° ORIGINAL COST <br />DISPOSALS - ITEMIZE IN DETAIL <br />YEAR ACQUIRED 100% <br />ORIGINAL COST <br />Ail Com <br />SCHEDULE H REAL ESTATE IMPROVEMENTS <br />During the past calendar year, did your business make improvements and /or other additions to real property, owned by your business? If yes, attach <br />a separate schedule with information on such improvements. YES ! NO <br />AFFIRMATION <br />LISTING FORM MUST BE SIGNED BY A LEGALLY AUTHORIZED PERSON - SEE INSTRUCTIONS <br />Under penalties prescribed by law, I hereby affirm that to the best of my knowledge and belief this listing, including any accompanying statements, inventories, <br />schedules, and other information, is true and complete. (if this is signed by an individual other than the taxpayer, he affirms that he is familiar with the extent and <br />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.) <br />Listing MUST be signed by the taxpayer, a principal officer of the taxpayer or a FULL -TIME employee of the taxpayer who has been officially empowered by the <br />principal officer to list the property. <br />��- y <br />SIgnah# Date Preparer Other Than Taxpayer Date <br />O dd F,"I%ce a Wi ( ' 1'{ t - O Z leg <br />Title 1 Telephone Number Address <br />Email Addreed Fax Number Telephone Number <br />Any Individual who willfully makes and subscribes an abstract listing required by the Subchapter (of the Revenue Laws) which he does not <br />believe to be true and correct as to every material matter shall be guilty of a Class 2 Misdemeanor. (Punishable by imprisonment of up to 60 days). <br />343 <br />