Personal Property Report Template Page 2
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1
2SECTION 2.
FURNITURE AND FIXTURES
(GROUP BY YEAR OF ACQUISITION)
(INCLUDING FULLY DEPRECIATED ASSETS)
FAIR
FAIR
YEAR OF
ACQUISITION
EFF.
TAB.
COST
YEAR OF
ACQUISITION
EFF.
TAB.
COST
MARKET
MARKET
ACQUISITION
COST
AGE
NO.
MULT.
ACQUISITION
COST
AGE
NO.
MULT.
VALUE
VALUE
15 YEARS
OR OVER
TOTAL FAIR MARKET VALUE
ASSESSED VALUE
SECTION 3.
MACHINERY AND EQUIPMENT
(GROUP BY YEAR OF ACQUISITION)
(INCLUDING FULLY DEPRECIATED ASSETS)
(EXCLUDE LICENSED MOTOR VEHICLES)
FAIR
FAIR
YEAR OF
ACQUISITION
EFF.
TAB.
COST
YEAR OF
ACQUISITION
EFF.
TAB.
COST
MARKET
MARKET
ACQUISITION
COST
AGE
NO.
MULT.
ACQUISITION
COST
AGE
NO.
MULT.
VALUE
VALUE
25 YEARS
OR OVER
TOTAL FAIR MARKET VALUE
ASSESSED VALUE
SECTION 4.
LEASEHOLD IMPROVEMENTS / MISC. PROPERTY
YEAR OF
COST
ITEM
ACQUISITION COST
EFF. AGE
TABLE
FAIR MARKET VALUE
ACQUISITION
MULT.
TOTAL FAIR MARKET VALUE
ASSESSED VALUE
SECTION 5.
CONSIGNED GOODS, LEASED, LOANED, OR RENTED EQUIPMENT, FURNITURE ETC.
ATTACH LIST SHOWING NAME, ADDRESS, TYPE AND AGE OF PROPERTY, MONTHLY RENTAL
_________________________________SIGNATURE AND VERIFICATION___________________________________
“I declare under the penalties for filing false reports (R.S. 14:125; up to 500.00 fine or imprisonment for one year or both, plus additional penalties
defined in Act 2330B of the 1989 Regular Session) that this return has been examined by me and to the best of my knowledge and belief is a true,
correct and complete return.” “This return must be signed by the taxpayer, authorized officer or partner and by the preparer before a Notary Public.”
_________________________________________________
___________
_________________________________________________
___________
SIGNATURE OF TAXPAYER
DATE
SIGNATURE OF PREPARER
DATE
Sworn to and subscribed before me this
Sworn to and subscribed before me this
____________ day of ________________________ 20 ______
____________ day of ________________________ 20 ______
___________________________________________________
___________________________________________________
NOTARY PUBLIC
NOTARY PUBLIC
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