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BUSINESS PROPERTY STATEMENT FOR 2021 FILE RETURN BY (County of Lake)

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BOE-571-L (P1) REV. 26 (05-20)
BUSINESS PROPERTY
STATEMENT FOR 2021
(Declaration of costs and other related
property information as of 12:01
A.M., January 1, 2021)
FILE RETURN BY APRIL 1, 2021
NAME AND MAILING ADDRESS
(Make necessary corrections to the printed name and mailing address)
LOCATION OF THE BUSINESS PROPERTY
STREET
CITY
RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED.
FILE A SEPARATE STATEMENT FOR EACH LOCATION.
PART I: GENERAL INFORMATION
COMPLETE (a) THRU (g)
a.
Enter type of business:
b. Enter local telephone number FAX number
Email Address
c. Do you own the land at this business location?
If yes, is the name on your deed recorded
as shown on this statement?
Yes No
Yes No
d. When did you start business at this location?
DATE:
If your business name or location has changed from last year, enter the former name
and/or location:
e. Enter location of general ledger and all related accounting records (include zip code):
f.
Enter name and telephone number of authorized person to contact at location of
accounting records:
(1) Did any individual or legal entity (corporation, partnership, limited liability company,
etc.) acquire a "controlling interest" (see instructions for denition) in this business
entity?
Yes
No
(2) If YES, did this business entity also own "real property" (see instructions for denition)
in California at the time of the acquisition?
Yes No
(3) If YES to both questions (1) and (2), ler must submit form BOE-100-B, Statement of
Change in Control and Ownership of Legal Entities, to the State Board of Equalization.
See instructions for ling requirements.
PART II: DECLARATION OF PROPERTY BELONGING TO YOU
(attach schedule for any adjustment to cost)
1. Supplies
2. Equipment (From line 35)
3. Equipment out on lease, rent, or conditional sale to others (Attach Schedule)
4. Bldgs., Bldg. Impr., and/or Leasehold Impr., Land Impr., Land (From line 71)
5. Construction In Progress (Attach Schedule)
6. Alternate Schedule A (See instructions)
7.
8.
COST
(omit cents)
(see instructions)
ASSESSOR’S USE ONLY
PART III:
DECLARATION OF PROPERTY BELONGING TO OTHERS – IF NONE WRITE “NONE”
(SPECIFY TYPE BY CODE NUMBER)
Year
Year
Description
Cost to
Annual
Report conditional sales contracts that are not leases on Schedule A
of
of
and Lease or
Purchase
Rent
1. Leased equipment 4. Vending equipment
t
Acq.
Mfr.
Identication
New
2. Lease-purchase option equipment 5. Other businesses
Number
3. Capitalized leased equipment 6. Government-owned property
Tax Obligation: A. Lessor B. Lessee
9. Lessor’s name
Mailing address
10. Lessor’s name
Mailing address
t
OWNERSHIP TYPE (R)
Proprietorship
Partnership
Corporation
______________Other
DECLARATION BY ASSESSEE
Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.
I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, including
accompanying schedules, statements or other attachments, and to the best of my knowledge and belief it is true, correct, and complete and includes all
property required to be reported which is owned, claimed, possessed, controlled, or managed by the person named as the assessee in this statement
at 12:01 a.m. on January 1, 2021.
BUSINESS
DESCRIPTION (R)
Retail
Wholesale
Manufacturer
Service/Professional
SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT*
t
DATE
NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed) TITLE
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
g.
During the period of January 1, 2020 through December 31, 2020:
*Agent: See page 7 for Declaration by Assessee instructions.
THIS STATEMENT SUBJECT TO AUDIT
INFORMATION PROVIDED ON A PROPERTY STATEMENT MAY BE SHARED WITH THE STATE BOARD OF EQUALIZATION
BOE-571-L (P2) REV. 26 (05-20)
SCHEDULE A — COST DETAIL: EQUIPMENT (Do not include property reported in Part III.)
Include expensed equipment and fully depreciated items. Include sales or use tax (see instructions for important use tax information), freight and installation costs.
Attach schedules as needed. Lines 18, 32, 33, and 45 "Prior" –– Report detail by year(s) of acquisition on a separate schedule.
2.
OFFICE FURNITURE
AND EQUIPMENT
ASSESSOR’S
COST
USE ONLY
L
I
Calendar
N
Year
E
of
Acq.
N
O
11
2020
12
2019
13
2018
14
2017
15
2016
16
2015
17
2014
18
2013
19
2012
20
2011
21
2010
22
2009
23
2008
24
2007
25
2006
26
2005
27
2004
28
2003
29
2002
30
2001
31
2000
32
1999
33
Prior
34
Total
COST ASSESSOR’S USE ONLY
1.
MACHINERY AND EQUIPMENT FOR
INDUSTRY, PROFESSION, OR TRADE
(do not include licensed vehicles)
35
3.
OTHER EQUIPMENT
(describe)
ASSESSOR’S
COST
USE ONLY
Calendar
Year
of
Acq.
2020
2019
2018
2017
2016
2015
2014
Prior
Total
4.
TOOLS, MOLDS,
DIES, JIGS
ASSESSOR’S
COST
USE ONLY
5a.
PERSONAL
Calendar
Year
COMPUTERS
of
Acq.
COST
2020
2019
2018
2017
2016
2015
2014
2013
2012
Prior
Total
ASSESSOR’S
USE ONLY
5b.
2020
Add TOTALS on lines 19, 33, 34, 46 and any additional schedules.
ENTER HERE AND ON PART II, LINE 2
2019
2018
2017
2016
2015
2014
2013
2012
Prior
Total
Calendar
Year
of
Acq.
ASSESSOR’S
COST
USE ONLY
LOCAL AREA NETWORK (LAN)
EQUIPMENT AND MAINFRAMES
36
ASSESSOR’S USE ONLY
PERS. PROP.
PERS. PROP. PERS. PROP.
37
CLASSIFICATION COL FULL VALUE BASE
FULL VALUE
RCLND
ADJUSTMENT FULL VALUE
Machinery
38
1
& equipment
Ofce furniture
39
2
& equipment
Tools, molds,
40
4
dies & jigs
41
Personal Computers
5a
42
LAN and Mainframe
5b
43
Other
44
3
equipment
Schedule B
45
_
— Fixtures
TOTALS
46
BOE-571-L (P3) REV. 26 (05-20)
SCHEDULE B — COST DETAIL: BUILDINGS, BUILDING IMPROVEMENTS, AND/OR LEASEHOLD IMPROVEMENTS, LAND IMPROVEMENTS,
LAND AND LAND DEVELOPMENT
Attach schedules as needed. Line 69 "Prior"–– Report detail by year(s) of acquisition on a separate schedule.
ASSESSOR’S ASSESSOR’S
COST
COST
USE ONLY USE ONLY
BUILDINGS, BUILDING IMPROVEMENTS, AND/OR
L
I
LEASEHOLD IMPROVEMENTS
N
1. 2.
E
STRUCTURE ITEMS ONLY FIXTURES ONLY
N
(see instructions) (see instructions)
O
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Calendar
Year
of
Acq.
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
Prior
Total
3.
LAND
IMPROVEMENTS
(e.g., blacktop, curbs, fences)
ASSESSOR’S
COST
USE ONLY
4.
LAND AND LAND
DEVELOPMENT
(e.g., ll, grading)
ASSESSOR’S
COST
USE ONLY
72
Have you received allowances for tenant improvements for the current reporting period that are not reported above?
Yes No If yes indicate amount $
71
Add TOTALS on line 70 and any additional schedules. ENTER HERE AND ON PART II, LINE 4
REMARKS:
BOE-571-L (P4) REV. 26 (05-20)
OFFICIAL REQUEST
DO NOT RETURN THESE 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 ofcial 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 Ofce by the date cited on the face of the form as required by law. Failure to le 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
le a property statement with the Assessor of that county whether or not you are requested to do so. Any person not otherwise required
to le 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-L.
THIS THIS STATEMENT IS NOT IF ANY SITUATION EXISTS WHICH
STATEMENT A PUBLIC DOCUMENT. THE NECESSITATES A DEVIATION FROM
IS SUBJECT INFORMATION DECLARED WILL TOTAL COST PER BOOKS AND RECORDS,
TO AUDIT. BE HELD SECRET BY THE ASSESSOR. FULLY EXPLAIN ALL ADJUSTMENTS.
INSTRUCTIONS
(complete the statement as follows)
NAME. If the information has been preprinted by the Assessor, make necessary corrections. INDIVIDUALS, enter the last name rst, then
the rst name and middle initial. PARTNERSHIPS must enter at least two names, showing last name, rst name and middle initial for each
partner. CORPORATIONS report the full corporate name. If the business operates under a DBA (Doing Business As) or FICTITIOUS
NAME, enter the DBA (Fictitious) name under which you are operating in this county below the name of the sole owner, partnership, or
corporation.
LOCATION OF THE PROPERTY. Enter the complete street address. Forms for additional business or warehouse locations will be
furnished upon request. A listing may be attached to a single property statement for your vending equipment leased or rented to others,
when any such properties are situated at many locations within this county.
USE TAX INFORMATION
California use tax is imposed on consumers of tangible personal property that is used, consumed, given away or stored in this state.
Businesses must report and pay use tax on items purchased from out-of-state vendors not required to collect California tax on their
sales. If your business is not required to have a seller’s permit with the
California Department of Tax and Fee Administration,
the
use tax may be reported and paid on your California State Income Tax Return or directly to the California Department of Tax and
Fee Administration
using the pay use tax for one-time purchase option available online. Obtain additional use tax information by
calling the California Department of Tax and Fee Administration's Customer Service Center at 1-800-400-7115 (TTY:711) or from the
website - www.cdtfa.ca.gov.
Part I:
GENERAL INFORMATION
[complete items (a) through (g)]
OWNERSHIP OF LAND — (c). Check either the YES or the NO box to indicate whether you own the land at the LOCATION OF THE
PROPERTY shown on this statement. If YES is checked, verify the ofcial RECORDED NAME on your DEED. If it agrees with the name
shown on this statement, check the second YES box. If it does not agree, check the second NO box.
LOCATION OF RECORDS — (e and f). Enter the address or addresses at which your general ledger and all related accounting records
are maintained and available for audit. If you enter your tax agent or representative’s address, indicate whether all or only part of the
records are at that address, and the location of the remainder, if applicable.
PROPERTY TRANSFER — (g).
Real Property – For purposes of reporting a change in control, real property includes land, structures, or xtures owned or held under
lease from (1) a private owner if the remaining term of the lease exceeds 35 years, including written renewal options, (2) a public owner
(any arm or agency of local, state, or federal government) for any term or (3) mineral rights owned or held on lease for any term, whether
in production or not.
BOE-571-L (P5) REV. 26 (05-20)
Controlling Interest – When any person or legal entity obtains more than 50 percent of the voting stock of a corporation, or more than
a 50 percent ownership interest in any other type of legal entity. The interest obtained includes what is acquired directly or indirectly by
a parent or afliated entity.
Forms, Filing Requirements & Penalty Information – Contact the Legal Entity Ownership Program Section at 916-274-3410 or refer
to the Board’s website at www.boe.ca.gov to obtain form BOE-100-B, applicable ling requirements, and penalty information.
Part II:
DECLARATION OF PROPERTY BELONGING TO YOU
Report full cost (100 percent of actual cost). Include excise, sales, and use taxes, freight-in, installation charges, and all other relevant
costs. Report any additional information which will assist the Assessor in arriving at a fair market value. Include nance charges for
buildings and improvements that are constructed or otherwise produced for an enterprise’s own use (including assets constructed or
produced by others) for which deposits or progress payments have been made. Do not include nance charges for purchased equipment.
LINE 1.
SUPPLIES. Report supplies on hand, such as stationery and ofce supplies, chemicals used to produce a chemical or physical
reaction, janitorial and lavatory supplies, fuel, sandpaper, etc., at their current replacement costs. Include medical, legal, or accounting
supplies held by a person in connection with a profession that is primarily a service activity. Do not include supplies which will become a
component part of the product you manufacture or
sell.
LINE 2. EQUIPMENT. Enter total from Schedule A, line 35 (see instructions for Schedule A).
LINE 3. EQUIPMENT OUT ON LEASE, RENT, OR CONDITIONAL SALE TO OTHERS. Report cost on line 3 and attach schedules
showing the following: equipment actually out on lease or rent, equipment out on a conditional sale agreement, and equipment held for
lease or rent which you have used or intend to use must be reported. Equipment held for lease or rent and not otherwise used by you is
exempt and should not be reported.
Equipment out on lease, rent, or conditional sale.
(1) Name and address of party in possession, (2) location of the
property, (3) quantity and description, (4) date of acquisition, (5) your cost, selling price, and annual rent, (6) lease or identication
number, (7) date and duration of lease, (8) how acquired (purchased, manufactured, or other — explain), (9) whether a lease or a
conditional sale agreement. If the property is used by a free public library or a free museum or is used exclusively by a public school,
community college, state college, state university, church, or a nonprot college it may be exempt from property t axes, p rovided the
lessor’s exemption claim is led by February 15. Obtain BOE
-263, Lessors’ Exemption Claim, from the Assessor. Also include equipment
on your premises held for lease or rent which you have used or intend to use. Report your cost and your selling price by year of
acquisition.
LINE 4.
BUILDINGS, BUILDING IMPROVEMENTS, AND/OR LEASEHOLD IMPROVEMENTS, LAND IMPROVEMENTS, LAND AND
LAND DEVELOPMENT. Enter total from Schedule B, line 71 (see instructions for Schedule B).
LINE 5. CONSTRUCTION IN PROGRESS. If you have unallocated costs of construction in progress for improvements to land, machinery,
equipment, furniture, buildings or other improvements, or leasehold improvements, attach an itemized listing. Include all tangible property,
even though not entered on your books and records. Enter the total on PART II, line 5.
LINE 6.
ALTERNATE OR IN-LIEU SCHEDULE. If the Assessor enclosed BOE-571-L, Alternate Schedule A, with this property statement,
complete the alternate schedule as directed and report the total cost on line 6.
LINES 7-8.
OTHER. Describe and report the cost of tangible property not reported elsewhere on this form.
Part III: DECLARATION OF PROPERTY BELONGING TO OTHERS
If property belonging to others, or their business entities, is located on your premises, report the owner’s name and mailing address. If it is
leased equipment, read your agreement carefully and enter A (Lessor) or B (Lessee), and whether lessor or lessee has the tax obligation.
For assessment purposes, the Assessor will consider, but is not bound to, the contractual agreement.
1. LEASED EQUIPMENT. Report the year of acquisition, the year of manufacture, description of the leased property, the lease
contract number or other identication number, the total installed cost to purchase (including sales tax), and the annual rent;
do not include in Schedule A or B (see No. 3, below).
2. LEASE-PURCHASE OPTION EQUIPMENT. Report here all equipment acquired on lease-purchase option on which the nal
payment remains to be made. Enter the year of acquisition, the year of manufacture, description of the leased property, the
lease contract number or other identication number, the total installed cost to purchase (including sales tax), and the annual
rent. If nal payment has been made, report full cost in Schedule A or B (see No. 3, below).
3. CAPITALIZED LEASED EQUIPMENT. Report here all leased equipment that has been capitalized at the present value of the
minimum lease payments on which a nal payment remains to be made. Enter the year of acquisition, the year of manufacture,
description of the leased property, the lease contract number or other identication number, and the total installed cost to
purchase (including sales tax). Do not include in Schedule A or B unless nal payment has been made.
BOE-571-L (P6) REV. 26 (05-20)
4. VENDING EQUIPMENT. Report the model and description of the equipment; do not include in Schedule A.
5. OTHER BUSINESSES. Report other businesses on your premises.
6. GOVERNMENT-OWNED PROPERTY. If you possess or use government-owned land, improvements, or fixed
equipment, or government-owned property is located on your premises, report the name and address of the agency which
owns the property, and a description of the property.
SCHEDULE A — COST DETAIL: EQUIPMENT
Do not include property already reported in Part III.
LINES 11-46.
Enter in the appropriate column the cost of your equipment segregated by calendar year of acquisition, include short-lived
or expensed equipment. Total each column. Report full cost; do not deduct investment credits, trade-in allowances or depreciation. Include
equipment acquired through a lease-purchase agreement at the selling price effective at the inception of the lease and report the year
of the lease as the year of acquisition (if nal payment has not been made, report such equipment in PART III). Report self-constructed
equipment used by you at the proper trade level in accordance with Title 18, section 10, of the California Code of Regulations. Exclude the
cost of normal maintenance and repair that does not extend the life nor modify the use of the equipment. Exclude the cost of equipment
actually removed from the site. The cost of equipment retired but not removed from the site must be reported. Segregate and report on
PART II, line 3, the cost of equipment out on lease or rent.
Include special mobile equipment (SE Plates). Exclude motor vehicles licensed for operation on the highways. However, you must
report overweight and oversized rubber-tired vehicles, except licensed commercial vehicles and cranes, which require permits
issued by the Department of Transportation to operate on the highways. If you have paid a license fee prior to January 1 on these large
vehicles, contact the Assessor for an Application for Deduction of Vehicle License Fees from Property Tax and le it with the Tax Collector.
Report overweight and oversized vehicles in Column 3.
Computers used in any application directly related to manufacturing, or used to control or monitor machinery or equipment, should
be reported in Column 1. Do not include application software costs in accordance with section 995.2 of the California Revenue and
Taxation Code. Personal Computers should be reported on Schedule A, column 5a; Local Area Network (LAN) equipment, including
LAN Components, and Mainframes should be reported on Schedule A, column 5b. Personal computers include the following: Desktops,
Docking Stations, Ink Jet Printers, Laptops, Laser Printers, Mini Towers, Monitors, Netbooks, Notebooks, PC Power Supply, Scanners,
Workstations. Local Area Network Equipment includes the following: External Storage Devices, Hubs, Mainframes, Network Attached
Storage Devices, Routers, Servers, Switches. LAN Components include, but are not limited to, the following: Network Disk & Tape Drives,
Network Fan Trays, Network Memory, Network Portable Storage Devices, Network Power Supply, Network Adaptors, Network Interface
Cards, Network Processors.
If necessary, asset titles in Schedule A may be changed to better t your property holdings; however, the titles should be of such clarity
that the property is adequately dened.
LINES 18, 32, 33 and 45.
For "prior" years acquisition, you must attach a separate schedule detailing the cost of such equipment by
year(s) of acquisition. Enter the total cost of all such acquisitions on lines 18, 32, 33 and 45.
LINE 35. Add totals on lines 19, Column 4; line 33, Column 5a; line 34, Columns 1, 2, 3; line 46, Column 5b; and any additional schedules.
Enter the same gure on PART II, line 2, that you entered in the box.
SCHEDULE B — COST DETAIL: BUILDINGS, BUILDING IMPROVEMENTS, AND/OR LEASEHOLD
IMPROVEMENTS, LAND IMPROVEMENTS, LAND AND LAND DEVELOPMENT
LINES 47-71.
Report by calendar year of acquisition the original or allocated costs (per your books and records) of buildings
and building or leasehold improvements; land improvements; land and land development owned by you at this location on
January 1. Include nance charges for buildings or improvements which have been constructed for an enterprise’s own use. If no
nance charges were incurred because funding was supplied by the owner, then indicate so in the remarks. In the appropriate
column enter costs, including cost of fully depreciated items, by the calendar year of acquisition and total each column. Do not include
items that are reported in Schedule A.
If you had any additions or disposals reported in Columns 1, 2, 3, or 4 during the period of January 1, 2
020 th
rough
December
31, 20
20
, attach a schedule showing the month and year and description of each addition and disposal. Enclosed
for this purpose is BOE-571-D, Supplemental Schedule for Reporting Monthly Acquisitions and Disposals of Property
Reported on Schedule B of the Business Property Statement. If additional forms are needed, photocopy the enclosed
BOE
-571-D.
BOE-571-L (P7) REV. 26 (05-20)
Segregate the buildings and building or leasehold improvements into the two requested categories (items which have dual function will be
classied according to their primary function). Examples of some property items and their most common categorization are listed below:
EXAMPLES OF STRUCTURE ITEMS, Column 1
EXAMPLES OF FIXTURE ITEMS, Column 2
An improvement will be classied as a structure when its
An improvement will be classied as a xture if its use or purpose
primary use or purpose is for housing or accommodation
directly applies to or augments the process or function of a trade,
of personnel, personalty, or xtures and has no direct
industry, or profession.
application to the process or function of a trade, industry,
Air conditioning (process cooling)
or profession.
Boilers (manufacturing process)
Air conditioning (except process cooling)
Burglar alarm systems
Boilers (except manufacturing process)
Conveyors (to move materials and products)
Central heating & cooling plants
Cranes — traveling
Craneways
Environmental control devices (used in production process)
Elevators
Fans & ducts (used for processing)
Environmental control devices (if an integral part of the
Floors, raised computer rooms
structure)
Furnaces, process
Fans & ducts (part of an air circulation system for the
Ice dispensers, coin operated
building)
Machinery fdns. & pits (not part of normal ooring fdns.)
Fire alarm systems
Permanent partitions (less than oor to ceiling)
Partitions (oor to ceiling)
Pipelines, pipe supports, pumps used in the production process
Pipelines, pipe supports & pumps used to operate the
Pits used as clariers, skimmers, sumps & for greasing in the trade
facilities of a building
or manufacturing process
Pits not used in the trade or process
Plumbing — special purpose
Railroad spurs
Power wiring, switch gear & power panels used in mfg. process.
Refrigeration systems (integral part of the building)
Refrigeration systems (not an integral part of the building)
Refrigerators, walk-in (excluding operating equipment)
Refrigerators, walk-in unitized; including operating equipment
which are an integral part of the building
Restaurant equipment used in food & drink preparation or service
Restaurants — rough plumbing to xtures
(plumbing xtures, sinks, bars, soda fountains, booths & coun-
Safes — imbedded
ters, garbage disposals, dishwashers, hoods, etc.)
Signs which are an integral part of the building excluding
Scales including platform & pit
sign cabinet (face & lettering)
Signs — all sign cabinets (face) & free standing signs including
Silos or tanks when primarily used for storage or
supports
distribution
Silos or tanks when primarily used for processing
Sprinkler systems
Store fronts
Television & radio antenna towers
LINE 69. If you have items reportable in Schedule B which were acquired in 1998 or previously, you must attach a
separate schedule detailing the cost of such items by year(s) of acquisition. Enter the total cost of such items on line 69.
LINE 71. Add totals on line 70 and any additional schedules. Enter the same figure on PART II, line 4 that you entered in
the box.
LINE 72.
Report tenant improvements for which you received allowances during this reporting period that are not reported on Schedule
B.
DECLARATION BY ASSESSEE
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 duciary, or a person authorized to
sign on behalf of the assessee. In the case of a corporation, the declaration must be signed by an ofcer or by an employee 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 certied public accountant, a public accountant, an enrolled
agent or a duly appointed duciary, the assessee’s written authorization of the employee or agent to sign the declaration on behalf of the
assessee must be led with the Assessor. The Assessor may at any time require a person who signs a property statement and who is
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 led. The penalty imposed
by section 463 of the Revenue and Taxation Code for failure to le is applicable to unsigned property statements.
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BUSINESS PROPERTY STATEMENT FOR 2021 FILE RETURN BY (County of Lake)

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Completed 13 February 2021

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