BOE-571-M

Source: https://www.boe.ca.gov/proptaxes/pdf/sample-boe571m.pdf

This page watermarked sample only. Contact BOE-571-M (P1) REV. 08 (07-25) Assessor for actual form. 20__ MISCELLANEOUS PROPERTY STATEMENT

(Declaration of costs and other related property information as of 12:01 A.M., January 1, 20__)

2. LOCATION OF THE PROPERTY: (File a separate statement for each location) FILE RETURN BY APRIL 1, 20__

Street Address City

3. DO YOU OWN THE LAND AT THIS LOCATION?

1. NAME AND MAILING ADDRESS Yes No (Make necessary corrections to the printed name and mailing address.) If yes, is the name on your deed recorded as shown on this statement. Yes No 4. LOCAL PHONE NUMBER ( ) E-Mail Address VETERANS: Are you filing a claim for veterans’ exemption? Yes NoTangible property owned, claimed, possessed, controlled, or managed by you at this location at 12:01 a.m., January 1 of the year being reported.Form

Inventories are exempt from taxation and should not be reported for 1980 and future years. Do not report property eligible for this exemption.

Yes NoTangible property owned, claimed, possessed, controlled, or managed by you at this location at 12:01 a.m., January 1 of the year being reported.Form Inventories are exempt from taxation and should not be reported for 1980 and future years. Do not report property eligible for this exemption.

DATE AC- ASSESSOR’S DESCRIPTION OF PROPERTY COST REMARKS
QUIRED USE ONLY 5. SUPPLIES X X X X ONLY

6. EQUIPMENT X X X X X X X X a. Total cost of all equipment held on January 1, last year X X X X Actual b. Equipment acquired since January 1, last year X X X X X X X X for c. Equipment disposed of since January 1, last year X X X X X X X X

   d. Total cost of all equipment held on January 1, this year X X X X

   MONTH & YEAR SAMPLE

INSTRUCTIONS: TOTAL FULL Line 5. Enter the cost of your supplies. VALUELine 6. List individually items acquired or disposed of sinceAssessorJanuary 1 of last year. Additional sheets may be attached. The figure to be entered on line d may be computed by adding the figures for lines a and b and subtracting the figure for line c. Line 7. Enter the date acquired, cost, and description of any other personal property at this location. Additional sheets may be at- tached. Line 8. Describe in detail and show the cost of all additions and retirements to your buildings, or to your leasehold improvements to PERSONAL PROPERTY the buildings of your landlord during the year being reported. Do not repeat items that were included in line 6. FIXTURES (IMPROVEMENTS) DECLARATION BY ASSESSEE PROCESSING DATA OWNERSHIP Note: The following declaration must be completed and signed. OPERATION BY DATE TYPE (4) If you do not do so, it may result in penalties. ANALYZED I declare under penalty of perjury under the laws of the State of California that I COMPUTEDProprietorship Contacthave examined this property statement, and that the foregoing and all information herein, including any accompanying statements or materials, is true, APPRAISEDPartnership correct, and complete to the best of the taxpayer's knowledge and belief, and Corporation includes all property required to be reported which is owned, claimed, REVIEWED possessed, controlled, or managed by the person named as the assessee in this POSTED TO: Other statement at 12:01 a.m. on January 1, 20 .

SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT* DATE

NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed) TITLE TAX AREA CODE:

BUS. CODE:

NAME OF LEGAL ENTITY (other than DBA) (typed or printed) FEDERAL EMPLOYER ID NUMBER

PREPARER’S NAME AND ADDRESS (typed or printed) TELEPHONE NUMBER TITLE ( )

• Agent: See P2 for Declaration by Assessee Instructions. THIS STATEMENT SUBJEC T TO AUDIT

This page watermarked sample only. Contact Assessor for BOE-571-M (P2) REV.08 (07-25) actual form.

INSTRUCTIONS

California law prescribes a yearly ad valorem tax based on property as it exists at 12:01 a.m. on January 1 (tax lien date). This
form constitutes an official request that you declare all assessable business property situated in this county which you owned,
claimed, possessed, controlled, or managed on the tax lien date, and that you sign (under penalty of perjury) and return the
statement to the Assessor’s Office by the date cited on the face of the form as required by law. Failure to file the statement during the
time provided in section 441 of the Revenue and Taxation Code will compel the Assessor to estimate the value of your property from other
information in the Assessor’s possession and add a penalty of 10 percent of the assessed value as required by section 463 of the Code.

If you own taxable personal property in any other county whose aggregate cost is $100,000 or more for any assessment year, you must file
a property statement with the Assessor of that county whether or not you are requested to do so. Any person not otherwise required to file
a statement shall do so upon request of the Assessor regardless of aggregate cost of property. The Assessor of the county will
supply you with a form upon request.

Except for the "DECLARATION BY ASSESSEE" section, you may furnish attachments in lieu of entering the information on this
property statement. However, such attachments must contain all the information requested by the statement and these
instructions. The attachments must be in a format acceptable to the Assessor, and the property statement must contain appropriate
references to the attachments and must be properly signed. In all instances, you must return the original BOE-571-M. Form
THIS THIS STATEMENT IS NOT IF ANY SITUATION EXISTS WHICH
STATEMENT A PUBLIC DOCUMENT. THE NECESSITATES A DEVIATION FROM
IS SUBJECT INFORMATION DECLARED TOTAL COST PER BOOKS AND
TO AUDIT. WILL BE HELD SECRET BY THE RECORDS, FULLY EXPLAIN ALL ASSESSOR. ONLYADJUSTMENTS. DECLARATION BY ASSESSEE Actual
The law requires that this property statement, regardless of where it is executed, shall be declared to be true under penalty of perjury
under the laws of the State of California. The declaration must be signed by the assessee, a duly appointed fiduciary, or a person
authorized to sign on behalf of the assessee. In the case of a corporation, the declaration must be signed by an officer or by an employee for
or agent who has been designated in writing by the board of directors, by name or by title, to sign the declaration on behalf of the
corporation. In the case of a partnership, the declaration must be signed by a partner or an authorized employee or agent. In the case of
a Limited Liability Company (LLC), the declaration must be signed by an LLC manager, or by a member where there is no manager, or by
an employee or agent designated by the LLC manager or by the members to sign on behalf of the LLC.

When signed by an employee or agent, other than a member of the bar, a certified public accountant, a public accountant, an enrolled
agent or a duly appointed fiduciary, the assessee’s written authorization of the employee or agent to sign the declaration on behalf of
the assessee must be filed with the Assessor. The Assessor may at any time require a person who signs a property statement and who is SAMPLE
required to have written authorization to provide proof of authorization.

A property statement that is not signed and executed in accordance with the foregoing instructions is not validly filed. The penalty
imposed by section 463 of the Revenue and Taxation Code for failure to file is applicable to unsigned property statements. Assessor

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