Assessor - Business Property Questionnaire

NEVADA COUNTY ASSESSOR
Rolf D. Kleinhans, Assessor

950 Maidu Avenue PO Box 599002 Nevada City, CA 95959 - 7902

(530) 265 - 1259

business.property@nevadacountyca.gov
Business Property Questionnaire
OFFICIAL REQUEST

This is a written request made pursuant to Sections 441(d) and 470 of the California Revenue and Taxation Code. This report must be completed in detail by the taxpayer and filed with the Assessor.

This statement is not a public document. The information contained herein will be held confidential by the Assessor pursuant to California Revenue and Taxation Code Sections 451 and 408. Attached schedules are considered to be part of the statement

Official records indicate that you are operator(s) of a business in Nevada County. Business property/equipment that is held or used in connection with a trade, business, or profession is subject to property tax and must be reported. This questionnaire serves as preliminary information to determine if and how this business property will be assessed.

Please complete the following, sign, and return within 20 business days. Thank you for your cooperation.
If you are an organization potentially exempt from property tax, please check here. You will be mailed an exemption claim form. You are still required to fully complete this questionnaire.*

YesNo
Tax Exempt Organizations: We will mail you a property exemption claim form; Please be aware you are still required to complete this questionnaire.
1) Name of Business (dba)*
2) Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
3) Business Location*

Street Address

Street Address Line 2

CityState

Zip Code
4) Nature of Business*
5) Date started in Nevada County or anticipated start date:*

MonthDayYear
Date
6) Owner (full name(s) or legal entity)*
6a) Type:*

Individual(s)LLCCorporationOther
Please list owners/members below:
Name
Title
Address

Street Address

Street Address Line 2

CityState

Zip Code
% of Stock Ownership
Name
Title
Address

Street Address

Street Address Line 2

CityState

Zip Code
% of Stock Ownership
Name
Title
Address

Street Address

Street Address Line 2

CityState

Zip Code
% of Stock Ownership
*Please attach additional sheet if necessary

7) Please list all equipment owned and used in the business below (items can be grouped in categories). Include additional sheet if necessary. A copy of a current depreciation schedule or asset list can be used instead.

	Description	Date Purchased	Cost (include sales tax)
1)
2)
3)
4)
5)
6)

8) Do you use any leased equipment?*

YesNo

9) Did you purchase this business?*

YesNo
Date of Purchase:*

MonthDayYear
Date
Prior Owner: *
Total Sales Price*
Goodwill
Inventory
Personal Property (Machinery & Equipment)
Other (Liquor License, etc.)
10) Have you sold the business?*

YesNo
Sales Price*
New Owner*
Sales Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Additional Remarks
I certify (or declare) under penalty of perjury under the laws of the State of California, that this statement, including anyaccompanying documentation, is true and correct, and that it is complete to the best of my knowledge and belief
Signature*

Clear
Date*

MonthDayYear
Date
Print Name*
Title*
Email*
example@example.com
Phone Number (8am-5pm)*
Please enter a valid phone number.
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NEVADA COUNTY ASSESSOR

Business Property Questionnaire

OFFICIAL REQUEST

Please list owners/members below: