Form of List

FORM OF LIST

TAXPAYER INFORMATION

PERSONAL PROPERTY

SIGNATURES AND SUBMISSION

A. Name of taxpayer

C. Indicate status

D. Annual certification of entity tax status

E. Nature of business or profession

F. State of formation

G. Date of formation

H. Business address

I. Location(s) of personal property

PERSONAL PROPERTY

Complete all sections that apply
INSTRUCTIONS FOR COMPLETING SCHEDULES

List all items of taxable personal property owned or held on January 1 in the appropriate schedules that follow, including items in your physical possession on that date under alease, consignment, license, mortgage, pledge or other arrangement. You must also list all real property owned in the city or town on January 1. For your return to beconsidered complete, all information specified in the schedules except the “Estimated Market Value” must be provided and all copies of leases, consignments, etc., for anyproperty in your possession under such arrangements must be attached. Construction work in progress (CWIP) and property no longer in service but not yet removed is taxableand must be listed separately as such, as shown in the tables. The board of assessors may require that this list be filed electronically

A. POLES, UNDERGROUND CONDUITS, WIRES AND PIPES.

B. MACHINERY. Includes manufacturing and generating machinery and equipment (turbines, engines, etc.), construction machinery, copying and reproduction equipment,automated data and word processing equipment, appliances (freezers, refrigerators, air conditioners, etc.), electronics (televisions, microwaves, etc.) and any other machinesand mechanical devices.

C. TOOLS AND EQUIPMENT. Includes trade, business, or professional tools and equipment, including restaurant, laboratory and medical equipment, not listed as machinery.

D. BUSINESS FURNITURE AND FIXTURES. Includes business, professional, commercial or service fittings and furnishings (desks, tables, cabinets, display cases), rugs, floorcoverings and draperies, lamps, specialized lease-hold improvements (restaurant fittings, modular walls, etc.), works of art and decorations, books and professional librariesand all other fittings and effects.

E. MERCHANDISE. Includes goods, wares, or stock in trade in any store or other place of sale, in any warehouse or other place of storage, out on lease or consignment, etc.

F. UNREGISTERED MOTOR VEHICLES AND TRAILERS. Includes motor vehicles not carrying Massachusetts registration plates under G.L. c. 90, unregistered agricultural(except those subject to the farm excise under G.L. c. 59, § 8A) and industrial tractors, trailers, snowmobiles, motorized golf carts and all other unregistered vehicles.

G. ANIMALS. Includes: (1) mules and horses one year or older, (2) neat cattle (cows, yearlings, bulls, steers, heifers, etc.) one to three years old and not held for the owner’spersonal consumption, (3) neat cattle three years or older, (4) swine, sheep and goats six months or older, (5) domestic fowl (chickens, ducks, geese, turkey), and (6) all otherdomestic animals, wildlife and gamefish (mink, fox, etc.) not subject to the farm excise under G.L. c. 59, § 8A.

H. FOREST PRODUCTS. Includes forest products severed from the soil such as cordwood, timber, Christmas trees and other forest products not subject to the classified forestproducts tax under G.L. c. 61.

I. OTHER TAXABLE PERSONAL PROPERTY. Include all other tangible personal property not specifically exempt from taxation, as well as Construction Work in Progress(CWIP). CWIP includes poles, wires, underground conduits and pipes in construction situated at a location for intended use when completed. It also includes machinerysituated at a location for intended use even if not actually connected to the system, but capable of functioning as machinery if so connected.

J. REAL PROPERTY. Includes all real property owned in the city or town on January 1.

* : Specify if property is owned, leased, consigned, etc. and attach copies of lease or other agreement with owner.

** : List property by most recent to earliest year of manufacture
MASTER SEE ATTACHED

A. Poles, underground conduits, wires and pipes

Rows	*Own/Other	Type	Quantity/Run feet	Size	Make	Nature of use	Years Installed	** Year of Manufacture	Year of purchase	Purchase price	Estimated market value
1
2
3

Subtotal (A) - Purchase Price
Subtotal (A) - Estimated Market Value
Continue list on attachment, in same format, as necessary

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Subtotal (A-Attachment) - Purchase Price*
Subtotal (A-Attachment) - Estimated Market Value*
Total (A) - Purchase Price
Total (A) - Estimated Market Value
SECTION A SEE ATTACHED

B. Machinery

Rows	*Own/Other	No.	Description	Nature of use	Manufacturer	Model	** Year of Manufacture	Year of purchase	Purchase price	Estimated market value
1
2
3

Subtotal (B) - Purchase Price
Subtotal (B) - Estimated Market Value
Continue list on attachment, in same format, as necessary

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Subtotal (B-Attachment) - Purchase Price*
Subtotal (B-Attachment) - Estimated Market Value*
Total (B) - Purchase Price
Total (B) - Estimated Market Value
SECTION B SEE ATTACHED

C. Tools and equipment

Rows	*Own/Other	No.	Description	Nature of use	Type/model	** Year of Manufacture	Year of purchase	Purchase price	Estimated market value
1
2
3

Subtotal (C) - Purchase Price
Subtotal (C) - Estimated Market Value
Continue list on attachment, in same format, as necessary

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Subtotal (C-Attachment) - Purchase Price*
Subtotal (C-Attachment) - Estimated Market Value*
Total (C) - Purchase Price
Total (C) - Estimated Market Value
SECTION C SEE ATTACHED

D. Business furniture and fixtures

Rows	*Own/Other	No.	Description	** Year of Manufacture	Year of purchase	Purchase price	Estimated market value
1
2
3

Subtotal (D) - Purchase Price
Subtotal (D) - Estimated Market Value
Continue list on attachment, in same format, as necessary

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Subtotal (D-Attachment) - Purchase Price*
Subtotal (D-Attachment) - Estimated Market Value*
Total (D) - Purchase Price
Total (D) - Estimated Market Value
SECTION D SEE ATTACHED

E. Merchandise

Rows	*Own/Other	Description	** Year of Manufacture	Year of purchase	Purchase price	Estimated market value
Finished goods or products
Work in progress
Materials or supplies

Subtotal (E) - Purchase Price
Subtotal (E) - Estimated Market Value
Continue list on attachment, in same format, as necessary

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Subtotal (E-Attachment) - Purchase Price*
Subtotal (E-Attachment) - Estimated Market Value*
Total (E) - Purchase Price
Total (E) - Estimated Market Value
SECTION E SEE ATTACHED

F. Unregistered motor vehicles and trailers

Rows	*Own/Other	Model, name, letter or number	Make	Type (number of passengers, doors, type of body, etc.)	No. of cylinders or rated capacity	** Year of manufacture	Year of purchase	Purchase price	Estimated market value
1
2
3

Subtotal (F) - Purchase Price
Subtotal (F) - Estimated Market Value
Continue list on attachment, in same format, as necessary

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Subtotal (F-Attachment) - Purchase Price*
Subtotal (F-Attachment) - Estimated Market Value*
Total (F) - Purchase Price
Total (F) - Estimated Market Value
SECTION F SEE ATTACHED

G. Animals

Subtotal (G) - Purchase Price
Subtotal (G) - Estimated Market Value
Continue list on attachment, in same format, as necessary

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Subtotal (G-Attachment) - Purchase Price*
Subtotal (G-Attachment) - Estimated Market Value*
Total (G) - Purchase Price
Total (G) - Estimated Market Value
SECTION G SEE ATTACHED

H. Forest products

Rows	*Own/Other	No.	Description	Purchase price (if applicable)	Estimated market value
1
2
3

Subtotal (H) - Purchase Price
Subtotal (H) - Estimated Market Value
Continue list on attachment, in same format, as necessary

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Subtotal (H-Attachment) - Purchase Price*
Subtotal (H-Attachment) - Estimated Market Value*
Total (H) - Purchase Price
Total (H) - Estimated Market Value
SECTION H SEE ATTACHED

I. Other taxable personal property (including CWIP)

Rows	*Own/Other	No.	Description	CWIP? (Mark with an X)	** Year of manufacture	Year of purchase	Purchase price	Estimated market value
1
2
3

Subtotal (I) - Purchase Price
Subtotal (I) - Estimated Market Value
Continue list on attachment, in same format, as necessary

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Subtotal (I-Attachment) - Purchase Price*
Subtotal (I-Attachment) - Estimated Market Value*
Total (I) - Purchase Price
Total (I) - Estimated Market Value
SECTION I SEE ATTACHED

J. Real property

Rows	Address	Use (Residence or business)
1
2
3

Continue list on attachment, in same format, as necessary

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SECTION J SEE ATTACHED

SIGNATURES AND SUBMISSION
A. SIGNATURE OF TAXPAYER

This list, prepared or examined by me, includes all taxable personal property owned or held by the maker of this list on January 1 (except, if applicable, property that must be listed on another local or central valuation property return) and to the best of my knowledge and belief, it and all accompanying schedules and statements are true, correct and complete.
Subscribed this Day* day of *, Year*, under the penalties of perjury.
Check here to agree
Signature*

Clear
Title of authorized officer*
Name of signer*
Address*
Phone Number*
Please enter a valid phone number.Format: 000 000-0000.
Email*
example@example.com
Fax Number
Please enter a valid fax number.Format: (000) 000-0000.
B. DESIGNATION OF REPRESENTATIVE

If it is your desire to be represented by an employee, attorney, accountant or other agent with respect to any matter associated with this list, indicate the name of the person you have authorized and to whom the contents of this list may be disclosed, along with the information requested.
Name of designated representative
Address
Phone Number
Please enter a valid phone number.Format: 000 000-0000.
Email
example@example.com
Fax Number
Please enter a valid fax number.Format: (000) 000-0000.
IMPORTANT: Please use the "Preview PDF" button below to review your finished PDF submission. Carefully review the preview document for inaccuracies or missing information
Should be Empty:

*Own/Other

Purchase price

Estimated market value