Form L-4175 D - Personal Property Statement Electrical Distribution Cooperative - Michigan Department Of Treasury

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Michigan Department of Treaury, STC

This form is issued under authority of P.A. 206 of 1893, as amended. Filing is mandatory Failure to file is

L-4175 D (Rev. 7-91)

punishable by fine and/or imprisonment, as stated by law. Any questions or comments regarding this statement

should be directed to the State Tax Commission prior to the Board of Review meeting held in March.

PERSONAL PROPERTY STATEMENT

ELECTRICAL DISTRIBUTION COOPERATIVE

As of December 31, 19

Cooperative

Area Code and Telephone No.

Address (No. & Street, City, State, ZIP)

City

Township

County

Assessing

Unit

(B)

(C)

(A)

Average Cost

Estimated Orig. Cost

Miles of Line Single-Phase

_________________ X $ __________________ = $ __________________________

Miles of Line Two-Phase

_________________ X $ __________________ = $ __________________________

Miles of Line Three-Phase

_________________ X $ __________________ = $ __________________________

Number of Services

_________________ X $ __________________ = $ __________________________

TOTAL (Add lines 1 thru 6)

$ __________________________

Percent Condition Factor (Schedule 1, Line 17, Col. I)

Depreciated Average Cost (Line 7 X Line 8)

10.

Other Taxable Personal Property (See attached schedule)

11.

TOTAL (Add lines 9 and 10)

12.

System Economic Factor

13.

True Cash Value (Line 11 X Line 12

14.

Assessed Valuation Based on Tentative Assessment Ratio

DID YOU HAVE IN YOUR POSSESSION IN THIS ASSESSING UNIT ON DECEMBER 31, 19 _______ TANGIBLE

PERSONAL PROPERTY BELONGING TO OTHERS, INCLUDING GOVERNMENTAL UNITS, WHICH IS NOT

REPORTED ABOVE?

YES*

* (If yes, attach a rider showing the name and addresses of the owners and the description of the property on lease, rental, loan, etc. If you are leasing or purchasing property

under a lease purchase contract, include that property on line 10 above.)

STATE OF MICHIGAN

}

COUNTY OF ___________________________________

I, ___________________________________________________________ being duly sworn depose and say that the

foregoing is a full and true statement of all tangible personal property of the taxpayer liable to taxation in the (Township,

City of _____________________________________________, ___________________________________________

County, Michigan on the 31st day of December 19 _____.

SignAture

Title

Subscribed and sworn to before me this ____________________ day of ____________________________, 19 _______.

Notary Public