Form 801b - Assessor Notification Property Claimed For More Than 12 Years - 2012 Page 2
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1
22012
2012
ASSESSOR NOTIFICATION
Form 801B
PROPERTY CLAIMED FOR MORE THAN 12 YEARS
(page 2)
A.
B.
C.*
D.
E.
F.
Property Description
State of Origin
Number
Original
Original
Assessed Value
Category
(if acquired
of Years
Assessment
Cost
(To be completed by
used)
Claimed
Year
local tax assessor.)
19. Machinery & Equipment ............
_______
16
________
_____________
__________
20. Furniture ....................................
_______
16
________
_____________
__________
21. Other .........................................
_______
16
________
_____________
__________
22. TOTALS (for columns E & F, add lines 19, 20 and 21) ...............................
_____________
__________
.60
23. Value Limitation .............................................................................................................................
__________
24. Allowable Assessed Value (in column F, multiply line 22 by line 23) .............................................
__________
25. Total Allowable Assessed Value (in column F, add lines 6, 12,18 and 24) ....................................
$ _________
SECTION 3. Property Tax Information (To be completed by local tax assessor.)
Property Tax Rate ___________________ Assessed Tax $ _____________________ For Taxes Assessed April 1, ___________
Assessor Signature ________________________________ Municipality Name _______________________ Date ___________
_________________________________________
______________________________________
________________
Taxpayer (or agent) Signature
Social Security Number or Federal EIN (see note, page 5)
Date
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