Fillable Form 2020: 571-L Part I GENERAL INFORMATION BUSINESS (San Bernardino County Assessor-Recorder-Clerk)

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Form 2020: 571-L Part I GENERAL INFORMATION BUSINESS (San Bernardino County Assessor-Recorder-Clerk)

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ASSESSOR’S PARCEL NUMBER
BOOK PAGE PCL PAR SEQ
REPORT CONDITIONAL SALES CONTRACTS THAT ARE NOT LEASES ON SCHEDULE A (SPECIFY TYPE BY CODE NUMBER)
1. Leased Equipment 4. Vending Equipment
2. Lease-Purchase Option Equipment 5. Other Businesses
3. Capitalized Lease Equipment 6. Government-Owned Property
Tax Obligation: A. Lessor B. Lessee
9. Lessor’s Name
Mailing Address
10. Lessor’s Name
Mailing Address
DECLARATION BY ASSESSEE
COMPANY NUMBER ACCOUNT NUMBER E-FILE DIR BIL
DIST USE RESPON LYA NAY
PRIOR
PN FIXTURES PERSONAL PROPERTY
BOB DUTTON ASSESSOR-RECORDER-COUNTY CLERK
222 W Hospit
ality Lane, 4th Floor, San Bernardino, CA 92415-0311
www.sbcounty.gov/arc
DECLARATION OF COSTS AND OTHER RELATED PROPERTY INFORMATION AS OF 12:01 A.M., JANUARY 1, 2020
RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED.
(909) 382-3220
FILE A SEPARATE STATEMENT FOR EACH LOCATION. MAKE NECESSARY
CORRECTIONS TO THE PRINTED NAME AND MAILING ADDRESS.
LOCATION OF THE BUSINESS PROPERTY —
STREET, CITY
THIS STATEMENT SUBJECT TO AUDIT
INFORMATION PROVIDED ON A PROPERTY STATEMENT MAY BE SHARED WITH THE STATE BOARD OF EQUALIZATION
COST (Omit Cents)
(see instructions)
Part III
DECLARATION OF PROPERTY BELONGING TO OTHERS — IF NONE WRITE “
NONE”
Year
of
Acq.
Year
of
Mfr.
Description and
Lease or
Identification
Number
Cost to
Purchase
New
Annual
Rent
ASSESSOR’S USE ONLY
APPLY AE LATE
10%PY
FILING
APPRAISER # _____________
_________________________
Date _____________________
Approval _________________
TELEPHONE NO.
*
AGENT:
See page 7 for Declaration By Assessee instructions.
BUSINESS
DESCRIPTION (
✓✓
✓✓
✓)
Retail
❑
Wholesale ❑
Manufacturer ❑
Service-Professional ❑
FILE RETURN BY
APRIL 1, 2020
Part I GENERAL INFORMATION
COMPLETE (a) THRU (g)
a. Enter type of business: __________________________________________________________
b. Enter local telephone no. _________________________ Fax No. ______________________
E-mail address _________________________________________________________
c. Do you own the land at this business location?
YES
❑ NO ❑
If “Yes,” is the name on your deed recorded
as shown on this statement? 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).
_______________________________________________________________________________
_______________________________________________________________________________
f. Enter name and telephone no. of authorized person to contact at location of accounting
records. ________________________________________________________________________
() ()
FIXTURES
PERSONAL PROP
TOTAL F.C.V.
g. During the period of JANUARY 1, 2019 through DECEMBER 31, 2019
(1) Did any individual or legal entity (corporation, partnership, limited
liability company, etc.) acquire a “controlling interest” (see
instructions for definition) in this business entity? . . . . . . . . . . YES
❑
NO
❑
(2) If YES, did this business entity also own “real property” (see
instructions for definition) in California at the time of the
acquisition? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES
❑
NO
❑
(3) If YES to both questions (1) and (2), filer 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 filing requirements.
ASSESSOR’S USE ONLY
FULL CASH VALUE ENROLLED VALUE
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.
▼
OWNERSHIP
TYPE (
✓✓
✓✓
✓)
Proprietorship
❑
Partnership ❑
Corporation ❑
Other ❑
COPIES:
_____ Assessee’s
ASSESSOR’S USE ONLY
2020
FEDERAL EMPLOYER ID #
(
▼
NAME AND MAILING ADDRESS
BOE-571-L (P1) REV. 25 (05-19)
FORM
571-L
BUSINESS PROPERTY STATEMENT
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, 2020.
NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed)
NAME OF LEGAL ENTITY (other than DBA) (typed or printed)
PREPARER'S NAME AND ADDRESS (typed or printed)
SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT*
)
TITLE
DATE
BOE-571-L (P2) REV. 25 (05-19)
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.
L
I
N
E
N
O
Calendar
Year
of Acq.
1.
MACHINERY AND EQUIPMENT FOR
INDUSTRY, PROFESSION, OR TRADE
(do not include licensed vehicles)
2.
OFFICE FURNITURE
AND EQUIPMENT
3.
OTHER EQUIPMENT
(describe)
4.
TOOLS, MOLDS,
DIES, JIGS
Calendar
Year
of Acq.
COST COST COST COST
ASSESSOR’S
USE ONLY
ASSESSOR’S
USE ONLY
ASSESSOR’S
USE ONLY
ASSESSOR’S
USE ONLY
COST
ASSESSOR’S
USE ONLY
Calendar
Year
of Acq.
Calendar
Year
of Acq.
COST
ASSESSOR’S
USE ONLY
5a.
PERSONAL
COMPUTERS
11
2019 2019
12
2018 2018
13
2017 2017
14
2016 2016
15
2015 2015
16
2014 2014
17
2013 2013
18
2012
Prior
19
2011
Total
20
2010
Total
21
2009
22
2008
23
2007 2019
24
2006 2018
25
2005 2017
26
2004 2016
27
2003 2015
28
2002 2014
29
2001 2013
30
2000 2012
31
1999 2011
32
1998
Prior
33 Prior Total
34 Total
35
Add TOTALS for lines 19, 33, 34, 46 and any additional
schedules. ENTER HERE AND ON PART II, LINE 2
Remarks
36
2019
37
2018
38
2017
39
2016
40
2015
41
2014
42
2013
43
2012
44
2011
45 Prior
46 Total
5b. LOCAL AREA NETWORK (LAN)
EQUIPMENT AND MAINFRAMES
1.
STRUCTURE ITEMS ONLY
(see instructions)
LAND IMPROVEMENTS, LAND AND LAND DEVELOPMENT
Attach schedules as needed. Line 69 “Prior” — Report detail by year(s) of acquisition on a separate schedule.
BUILDINGS, BUILDING IMPROVEMENTS, AND/OR
LEASEHOLD IMPROVEMENTS
L
I
N
E
N
O
Calen-
dar
Yr.
of
Acq.
BOE-571-L (P3) REV. 25 (05-19)
SCHEDULE B — COST DETAIL: BUILDINGS, BUILDING IMPROVEMENTS, AND/OR LEASEHOLD IMPROVEMENTS,
ASSESSOR’S
USE ONLY
2.
FIXTURES ONLY
(see instructions)
ASSESSOR’S
USE ONLY
ASSESSOR’S
USE ONLY
ASSESSOR’S
USE ONLY
3.
LAND IMPROVEMENTS
(e.g., blacktop, curbs, fences)
4.
LAND AND LAND DEVELOPMENT
(e.g., fill, grading)
COST COST COST COST
47
2019
48
2018
49
2017
50
2016
51
2015
52
2014
53
2013
54
2012
55
2011
56
2010
57
2009
58
2008
59
2007
60
2006
61
2005
62
2004
63
2003
64
2002
65
2001
66
2000
67
1999
68
1998
69
PRIOR
70
TOTAL
71
Add Totals on Line 70 and any additional schedules ENTER HERE AND ON PART II, LINE 4
72 Have you received allowances for tenant improvements for the current reporting period that are not reported above?


 Ye s
No
If yes indicate amount $ __________________ .
REMARKS: ______________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
BOE-571-D (P1) REV. 21 (05-19)
SUPPLEMENTAL SCHEDULE FOR REPORTING
MONTHLY ACQUISITIONS AND DISPOSALS OF
PROPERTY REPORTED ON SCHEDULE B OF THE
BUSINESS PROPERTY STATEMENT
OWNER NAME
MAILING ADDRESS
LOCATION OF PROPERTY
INSTRUCTIONS
Report all acquisitions and disposals reported in Columns 1, 2, 3, or 4 on Schedule B for the period January 1, 2019 through
December 31, 2019. Indicate the applicable column number in the space provided.
ADDITIONS — Describe and enter the total acquisition cost(s), including excise, sales, and use taxes, freight-in, and installation charges,
by month of acquisition; transfers-in should also be included. The former property address and date of transfer should be reported, as well
as original date and cost(s) of acquisition.
Only completed projects should be reported here (e.g., the date the property becomes functional and/or operational, otherwise it should
be reported as construction-in-progress).
Identify completed construction that was reported as construction-in-progress on your 2019 property statement. Describe the item(s)
and cost(s), as previously reported, on a separate schedule and attach to BOE-571-D.
DISPOSALS — Information on this property should include the disposal date, method of disposal (transfer, scrapped, abandoned, sold,
etc.) and names and addresses of purchasers when items are either sold or transferred.
ADDITIONS DISPOSALS
FROM
COLUMN
NUMBER
ENTER MONTH
& YEAR OF
ACQUISITION
DESCRIPTION COST
FROM
COLUMN
NUMBER
ENTER MONTH
& YEAR OF
DISPOSAL
YEAR
ACQUIRED
DESCRIPTION COST
THIS STATEMENT SUBJECT TO AUDIT
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Form 2020: 571-L Part I GENERAL INFORMATION BUSINESS (San Bernardino County Assessor-Recorder-Clerk)

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Completed 31 January 2021

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