Form B-116 - Supplemental Schedule To Form 571-L For Service Station And/or Car Wash - 2017

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2017
2017
SUPPLEMENTAL SCHEDULE TO FORM 571-L
FOR
SERVICE STATION AND/OR CAR WASH
NAME
COMPANY NO.
LOCATION OF PROPERTY
ROUTE
SITUS
COST DETAIL: EQUIPMENT Include equipment expensed and fully depreciated items. Include excise, sales or use taxes, freight-in, and installation
costs. Attach schedules as needed. Line 42 “Prior” - Report detail by year(s) of acquisition on separate schedule.
L
SIZE
NUMBER
ACQUISITION
I
OR
OF
DESCRIPTION
COST
ASSESSOR’S USE ONLY
N
DATE
CAPACITY
UNITS
E
45
(1)
UNDERGROUND
TANKS AND ATTACHED
$
1
25
EQUIPMENT
100
2
3
4
5
6
7
$
8
TOTAL
0
46
(2)
$
FUEL DISPENSERS/PUMPS
9
12
100
10
11
12
13
14
15
16
$
TOTAL
0
17
(3)
29
SERVICE STATION/CAR WASH
$
18
HOISTS AND SIGNS
12
100
19
20
21
22
23
$
TOTAL
0
$
24
Add totals on lines 8, 17, 23, and any additional schedules.
Enter here:
0
(4)
(5)
(6)
67
73
88
(7)
28
L
CALENDAR
OTHER
STORE
POINT OF SALE
CAR WASH EQUIPMENT
I
SERVICE STATION
YEAR OF
Point of Sale, Control Consoles, Card
Report Process Wiring and
AND MINI - MART
N
Readers, etc.
EQUIPMENT
Plumbing on Schedule B (571-L)
ACQ.
12
8 UNT
EQUIPMENT
12
E
Report computers on 571-L.
55
0
100
ASSESSOR’S USE ONLY
COST
ASSESSOR’S USE ONLY
COST
ASSESSOR’S USE ONLY
COST
ASSESSOR’S USE ONLY
2016
$
$
$
$
25
2015
26
2014
27
2013
28
2012
29
2011
30
2010
31
2009
32
2008
33
2007
34
2006
35
2005
36
2004
37
2003
38
2002
39
2001
40
2000
41
Prior
42
TOTAL
$
$
$
$
43
0
0
0
0
$
44
Add totals on lines 24, 43 and any additional schedules.
Enter here and on Line 6, Part II, Page (P1)
0
REMARKS
B-116A (FRONT) (REV. 9-16)

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