Form L-4175 - Personal Property Statement - 2015
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Must be filed by February 20, 2015.*
Michigan Department of Treasury
Parcel No.
632 (Rev. 12-14)
2015
Issued under authority of Public Act 206 of 1893.
L-4175
Approved by the State Tax Commission October 13, 2014.
2015 Personal Property Statement
(As of 12-31-14)
Location(s) of Personal Property Reported on This Statement.
FROM:
(Name and Address of Assessor)
LIST ALL LOCATIONS. Attach additional sheets if necessary.
Square Feet
Date of Organization
Date Business Began at
Occupied
above location
Assumed Names Used by Legal Entity, if any
TO:
Names of Owner(s) or Partners
(Name and Address of Taxpayer)
(If sole proprietorship or partnership)
If Sole Proprietorship, Taxpayer's Residential Address
Legal Name of Taxpayer
Address Where Personal Property Records are Kept
Check One Only:
Preparer's Name, Address and Telephone Number and E-mail address
Sole Proprietorship
Name of Person in Charge of Records Taxpayer Telephone No.
Partnership
Limited Liability Co.
Description of Taxpayer's Business Activity and NAICS Code
Corporation
MI ID# ______________
NOTICE: If the true cash value of the assessable personal property you or a related entity own, lease, or possess is under $80,000, you may
be excused from completing this form. File Affidavit of Owner of Eligible Personal Property Claiming Exemption from Collection of Taxes
(Form 5076) by February 10, 2015 if you qualify. See the statement at the beginning of the Instructions on Page 5.
SUMMARY AND CERTIFICATION. Complete ALL questions.
1.
Mandatory disclosure of Eligible Manufacturing Personal Property (EMPP), per MCL 211.19(9) (see NOTICE on page 5 of the instructions). The
undersigned states that
All
Part
None of the personal property reported on this personal property statement is EMPP. If you check the
"Part" box, you must complete and attach Form 5201. Please check only one box.
2.
Have you excluded reporting of any exempt "Special Tools" and/or air/water pollution
If Yes, enter total original cost
control facilities, and/or wind/water energy conversion devices? See page 6 of the
of special tools: _________.
instructions.
Yes
No
Attach a list of certificates.
3.
Have you reported all of your assessable tangible personal property located in
Michigan to the appropriate assessment jurisdiction, including all fully-depreciated or
expensed assets that are assessable?
Yes
No
If No, attach explanation.
4.
Did you hold a legal or equitable interest in personal property assessable which you
have not reported on this statement (see instructions) and/or have any of your assets
If Yes, attach itemized list(s)
been subjected to "rebooking" of costs for accounting purposes or been purchased
and other documentation
used?
required by instructions.
Yes
No
5.
Are you a party (as either a landlord or a tenant) to a rental or lease agreement relating
to real property in this jurisdiction?
Yes
No
If Yes, complete Section O.
6.
Is any of your property "daily rental property," per P.A. 537 of 1998?
If Yes, attach Form 3595.
Yes
No
7.
Are other businesses operated at your location(s)?
Yes
No
If Yes, attach itemized list.
Enter zero if appropriate.
Assessor Calculations
8a.
8.
Grand total from page 2
8b.
9a.
9.
Grand total from page 3
9b.
10a.
10.
Grand total from page 4
10b.
X .50
11a.
11.
Total cost of Personal Property Construction in Progress
11b.
Total cost of Cable TV, Utility and Wind Energy Assets from forms 633, 3589 and 4565
12a.
12.
12b.
13.
Total cost of Idle or Obsolete or Surplus Equipment and Cellular Site
13a.
Equipment from Form(s) 2698 and 4452.
13b.
TOTAL
The undersigned certifies that he/she is an owner, officer and/or the duly authorized
ASSESSOR'S ADJUSTMENT(S)
agent for the above named taxpayer and that the above summary, with its supporting
EXEMPTION(S)
documents, provides a full and true statement of all tangible personal property
owned or held by the taxpayer at the locations listed above on December 31, 2014.
TRUE CASH VALUE
Signature of Certifier
Date
ASSESSED VALUE (50% of TCV)
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