2019 Personal Property Declaration – Motor Vehicle Form
For Owners of non-Connecticut registered or non-registered vehicles such as vehicle types listed below
List or Account #: Assessment date October 1, 2019
Owner’s Name:
Required return date November 4, 2019
ddress Location of personal property in this town.
City/State/Zip
Phone / Fax ( )
/
( )
E-Mail
Copy and attach additional sheets if needed for additional vehicles
#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 this 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 this town below:
Vehicle type: Camp Trailer Travel Trailer Park Model Motor Home Fifth Wheel
(check one) Pick-up Camper, slide-on Pick-up Camper, chassis-unit Slide Outs
Motorcycle Motor Scooter Snowmobile
Golf Cart Off-road construction vehicle Passenger Car
Registered
No Yes
give town and state
Marker Plate
Purchase Date: Purchase Price:
Vehicle Description and Information Additional Description for Truck/Trailer/Campers
Year Length
Make Width
Model Weight
Body Engine Type
Color Chassis
VIN
VALUE $ #9
#25 – Penalty for failure to file as required by statute – 25% of assessment #25
Asse
ssor’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 Pr
operty Declaration must be signed above and delivered to the Assessor of this town 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
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signature
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