Form L-4175 - Personal Property Statement - 2002
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Michigan Department of Treasury, STC
Parcel No.
632 (Rev. 8-01)
FROM:
(Name and Address of Assessor)
PERSONAL PROPERTY
STATEMENT - 2002
(As of 12-31-01)
Location(s) of Personal Property Reported on This
Statement. (Attach additional sheets if necessary)
TO:
(Name and Address of Taxpayer)
TAXPAYER
-
LIST
ALL
LOCATIONS
ABOVE.
READ
INSTRUCTIONS
CAREFULLY. PLEASE FILE BY FEBRUARY 1, 2002.*
ADDITIONAL NOTICES
ARE FOUND IN THE INSTRUCTIONS.
2002
Legal Name of Taxpayer
(Check One)
Date of Organization
Date Business Began at Above Location
Sole Proprietorship
Address Where Personal Property Records are Kept
Assumed Names Used by Legal Entity, if any
Partnership
Limited Liability Co.
Names of Owner(s) or Partners
Name of Person in Charge of Records
Taxpayer Telephone No.
MI ID# ______________
(If sole proprietorship or partnership)
Corporation
Description of Taxpayer's Business Activity
Sq. Ft. Occupied
MI ID# ______________
Preparer's Name, Address and Telephone No.
Michigan Sales Tax No.
If Sole Proprietorship, Taxpayer's Residential Address
SUMMARY AND CERTIFICATION
(Complete the following section. ALL QUESTIONS MUST BE ANSWERED. Enter Zero if appropriate.)
1.
Have you excluded any exempt "Special Tools" from this statement?
Yes
No (If Yes, state total original cost excluded: ________________)
2.
Have you excluded any air and water pollution control facilities and/or wind or water energy conservation devices for
which an exemption certificate has been issued?
Yes
No (If Yes, attach itemized listing required by instruction).
3.
Have you, to the best of your knowledge, reported all of your assessable tangible personal property located in Michigan to the
appropriate assessment jurisdiction?
Yes
No (If No, attach explanation.)
4.
Did you hold a legal or equitable interest in personal property assessable in this jurisdiction which you have not reported on this
statement? (See instructions.)
Yes
No (If Yes, attach required list.)
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.
Have any of your assets been subjected to "rebooking" of costs for accounting purposes or been purchased used?
(See instructions.)
Yes
No (If Yes, attach required list.)
7.
Is any of your property "daily rental property", per P.A. 537 of 1998?
Yes
No (If yes, attach required form 3595)
8.
Have you reported all fully depreciated or expensed assets that are assessable?
Yes
No
9.
Are other businesses operated at your location(s)?
Yes
No (If Yes, attach a list.)
Assessor Calculations
10a.
10.
Grand total from page 2
10b.
11a.
11.
Grand total from page 3
11b.
12a.
12.
Grand total from page 4
12b.
13a.
13.
Total cost of Idle Equipment from form 2698
13b.
14a.
X .50
14.
Total cost of Personal Property Construction in Progress
14b.
15a.
15.
Total cost of Cable Television and Utility Assets from form 3589
15b.
TOTAL
The undersigned certifies that he/she is an owner, officer and/or the duly authorized agent
ASSESSOR'S ADJUSTMENT(S)
for the above named taxpayer and that the above summary, with its supporting
documents, provides a full and true statement of all tangible personal property owned or
EXEMPTION(S)
held by the taxpayer at the locations listed above on December 31, 2001.
TRUE CASH VALUE
Signature of Certifier
ASSESSED VALUE (50% of TCV)
Date
L-4175
SIGN HERE
Form approved by STC on 09-05-01
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