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F O R M 571-STR SHORT TERM RENTAL PROPERTY STATEMENT DONALD O'CONNOR, ASSESSOR-RECORDER COUNTY OF ALPINE P.O. Box 155 Markleeville, CA 96120 • Phone (530) 694-2283 2020. 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. FILE RETURN BY APRIL 2, 2020 ASSESSOR’S USE ONLY ACCOUNT NUMBER ASSESSOR’S USE ONLY ASSESSOR’S USE ONLY APN NAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address.) LOCATION/ADDRESS OF THE PROPERTY (street, city) (file a separate statement for each location) PART 1: GENERAL INFORMATION Local Telephone Number ( ) Fax Number ( ) E-Mail Address Enter location of general ledger and all related accounting records (include zip code): STREET CITY STATE ZIP PART 2: LEASED PROPERTY ASSESSOR'S USE ONLY 3. Do you own the personal property household furniture and personal effects) located at your short term rental property location? Yes No If NO, list below NAME AND ADDRESS OF OWNER AND DESCRIPTION OF SUCH PROPERTY PART 3: DECLARATION OF PERSONAL PROPERTY BELONGING TO YOU [use Schedule A on page 2 to complete totals below.] 4. Supplies Enter cost estimate of supplies consumed by rental guests $ 5. Furniture & belongings Enter total costs from page 2 $ 6. Kitchen Appliances Enter total costs from page 2 $ 7. Other equipment Enter total costs from page 2 $ TOTAL PERSONAL PROPERTY $ Sign here I declare under penalty of perjury under the laws of 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. OWNER SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT ► DATE NAME OF ASSESSEE OR AUTHORIZED AGENT (typed or printed) ► DATE PREPARER'S NAME AND ADDRESS (typed or printed) ► DATE THIS STATEMENT SUBJECT TO AUDIT Over Page 1 of 2 ---PAGE BREAK--- SCHEDULE A – COST DETAIL: FURNITURE & EQUIPMENT Table to itemize belongings Section 1(a) of article XIII of the California Constitution provides that all property is taxable unless otherwise exempted. Therefore, all home furnishings that are used in a short term rental property – including dishware, sofas, mattresses and bedding – are subject to personal property taxes. One by one, please list EACH ITEM per room contained in the short term rental property and estimate cost and year that items were acquired. If additional space is needed, please attach additional sheet. For assistance or questions, e-mail us at [EMAIL REDACTED] or call us at [PHONE REDACTED]. Year acquired Bedroom #1 furniture & belongings Original cost Year acquired Living area furniture & belongings Original cost Year acquired Kitchen appliances Original cost Mattress Sofa Dishware Box Spring Chairs Flatware Bedframe Rug Pots and pans Pillows and bedding TV Cooking utensils Duvet cover / blanket Table Refrigerator Bureau / chest of drawers Storage chest of drawers Microwave Rug Table lamp Toaster Mirror Floor lamp Coffee maker Table lamp Mirror Blender Floor lamp Artwork: painting/picture Ice maker Artwork: painting/picture Clocks Other TV Other Other Total Total Total Year acquired Bedroom #2 furniture & belongings Original cost Year acquired Dining area furniture & belongings Original cost Year acquired Other equipment Original cost Mattress Buffet / hutch cabinet Clothes washer Box Spring Dining table Clothes dryer Bedframe Chairs Vacuum cleaner Pillows and bedding Rug Computers Duvet cover / blanket Table lamp Bikes Bureau / chest of drawers Floor lamp Sports equipment Rug Mirror Security systems Mirror Artwork: painting/picture Outdoor playground Table lamp Clocks Patio furniture Floor lamp Other Gazebo Artwork: painting/picture Portable hot tub TV Other Other Total Total Total Year acquired Bedroom #3 furniture & belongings Original cost Year acquired Bathroom(s) furniture & belongings Original cost Add up TOTAL COSTS for FURNITURE & BELONGINGS as listed in both the left and center columns and carry forward the total sum to the front page, line 5. Add up TOTAL COSTS for Appliances as listed in the upper right column and carry forward the total sum to the front page, line 6. Add up TOTAL COSTS for Equipment as listed in the mid right column and carry forward the total sum to the front page, line 7. Mattress Bath towels Box Spring Hand towels & washcloths Bedframe Bath rug Pillows and bedding Other Duvet cover / blanket Bureau / chest of drawers Rug Mirror Table lamp Floor lamp Artwork: painting/picture TV Other Total Total Page 2 of 2