2019 Personal Property Declaration – Motor Vehicle Camper Form
For Owners of non-Connecticut registered vehicles such as camping type vehicles not registered in Connecticut
List or Account #: Assessment date October 1, 2019
Owner’s Name:
Required return date November 4, 2019
ddress Location of personal property
City/State/Zip
Phone / Fax ( )
( )
E-M
il
Taxable Property Information copy and attach additional sheets if needed
#9 MOTOR VEHICLES Unregistered motor vehicles (e.g. campers, RV’s, snowmobiles, trailers, trucks, passenger cars, tractors, off-road construction
vehicles, etc.) including any vehicle garaged in «Town» but registered in another state or another Connecticut town, or any such vehicle not registered.
ASSESSOR’S USE
ONLY
Describe your personal property located in «Town» below:
Campground name: Campground Site #
t campground from to Property there year round Yes No
Vehicle type: Camp Trailer Travel Trailer Park Model Motor Home Fifth Wheel
(check all boxes that apply) Pick-up Camper, slide-on Pick-up Camper, chassis- Slide Outs
Vehicle Description and Information Yea
Make Model # VIN
Model Name: Make of engine:
Make of chassis
Length: Width: Purchase date: Purchase price:
Registered: Yes No Marker #: Where registered:
IF REGISTERED IN ANOTHER CONNECTICUT TOWN OR OUT-OF-STATE YOU
MUST PROVIDE A COPY OF THE CURRENT REGISTRATION
VALUE $ #9
Site and Non-registered Motor Vehicle Information:
Improvement
Yes No Size Wood or Metal VALUE
#24
Deck X
Screen
orch X
Sun Room
with windows
X
Cano
not awnin
s
X
Shed X
Non-
e
istered MV Yes No Yea
Make Model VALUE
Golf Cart
TV
Motorc
cle
Motor scoote
Other
describe
>
#25
Penalt
for failure to file as re
uired b
statute
25% of assessment #25
ssessor’s Final Assessment Total >
Personal Property Declaration Affidavit
This form must be signed (and in some cases witnessed) before it may be filed with the Assessor.
Avoid Penalty - Notarize Personal Property Declaration signed by agent.
I DO HEREBY declare under penalty of false statement that all sections of this declaration have been completed according to the best of my knowledge, remembrance, and belief; that
it is a true statement of all my personal property liable to taxation; and that I have not conveyed or temporarily disposed of any estate for the purpose of evading the laws relating to the
assessment and collection of taxes.
Ow
ner’s
Signature
Date
Owner’s Signature (print owner’s name on line below)
Print or type owner’s name
I DO HEREBY declare under oath that I have been duly appointed agent for the owner of the property listed above and that I have full authority and knowledge sufficient to file a
ro
er declaration for him in accord with the
rovisions of
12-50 C.G.S.
Agen
t’s
Signature
Date
Agent’s Signature (print agent’s name on line below)
Print or type agent’s name
Witness of agent’s sworn statement
Subscribed and sworn to before me -
Date
Assessor or staff member, Town Clerk, Justice of the Peace, Notary or Commissioner of Superior Court
The Personal Property Declaration must be signed above and delivered to the Assessor or postmarked (as defined in
C.G.S. Sec 1-2a) by Monday, November 4, 2019 – a 25% Penalty required for failure to file as required.
click to sign
signature
click to edit
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click to sign
signature
click to edit
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