Agenda Package - 11-19-12 Reg. Meeting

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'9x 1 2- c-P I scntUUt_e U SEPARATELY SCHEDULED PROPERTY 1. Does your business own any artwork, displays, statues, or other personal property that is separately scheduled for insurance purposes? (_; YES CO NO Please describe the items and estimated value of items if applicable. SCHEDULE E FARM EQUIPMENT Does your business own any tractors and /or other farm equipment? . YES Q NO `> Cost on Schedule A If so, list and attach separate schedule. If listed by cost on Schedule A, indicate above but still include information on separate schedule. SCHEDULE F I INTANGIBLE PERSONAL PROPERTY 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 exempt owner? :: YES NO If yes, include lease information below. Attach additional schedule if necessary. NAME AND ADDRESS OF OWNER DESCRIPTION OF PROPERTY AND LEASE E I MONTHLY PAYMENT ACCT. # SCHEDULE G ACQUISITIONS AND DISPOSALS DETAIL Acquisitions and disposals detail of machinery, equipment, furniture and fixtures and computer equipment, and leasehold Improvements in the prior year. If there is not enough room below, attach separate schedule. ACQUISITIONS - ITEMIZE IN DETAIL 100"o ORIGINAL COST DISPOSALS - ITEMIZE IN DETAIL YEAR ACQUIRED 100% ORIGINAL COS SCHEDULE H REAL ESTATE IMPROVEMENTS During the past calendar year, did your business make improvements and /or other additions to real property, owned by your 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 is signed by an individual other than the taxpayer, he affirms that he is familiar with the extent and true value of all the taxpayers property subject to taxation in this county and that his affirmation is based on all the information of which he has any knowledge.) 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 principal officer to list the props . e- - Signature Date Preparer Other Than Taxpayer Date Tifle Telephone Number Address Email Address Fax Number Telephone Number Any Individual who willfully makes and subscribes an abstract listing required by the 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. (Punishable by imprisonment of up to 60 days). 2- c-P I