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                                                    GREENE COUNTY ASSESSOR 
   BRENT JOHNSON                                    940 N Boonville Ave Rm 37           2023 BUSINESS ASSESSMENT LIST
   Assessor, Greene County, MO Springfield, MO 65802-3802Dear Business Owner / Manager:                                                     You are required by law to provide a list, indicating type, 
   940 North Boonville Ave., Rm. 37                                                     year purchased and original cost, for all tangible personal property, e.g. Vehicles, Computers & Office 
                                                                                        Equipment, Furniture, Fixtures, Manufacturing Equip. & Tooling, etc., belonging to you or under the 
   Springfield, MO 65802-3802                                                           control of your company in Greene County, Missouri, on Jan. 1st. Complete this form, sign and return it 
   Phone: 417-868-4892   BusinessProperty@greenecountymo.gov                            before March 1st to avoid penalty. 
   Fax:  417-829-6193   greenecountymo.gov/assessor                                                 Follow instructions below and on back.

        AVOID PENALTY Return by March 1st

   Name:

   Address:                                                                             BRENT JOHNSON
                                                                                        GREENE COUNTY ASSESSOR
                                                                                        940 NORTH  BOONVILLE AVE  RM 37
                                                                                        SPRINGFIELD MO  65802-3802
   City, State, Zip:
                                                                                        E-File - Scan QR code or Go to:

If you report under any other name, write that name above.
 DBA:__________________________________________________
If business was closed or sold, give date _____________________.
Using a PO Box?  If so, please list physical location below.
HAS YOUR ADDRESS CHANGED?    9 NO    9 YES  New Address        ___________________________________________________________________ *            Date Moved ________________
                                                                Street                       City                                     State Zip
*REQUIRED – LIST LOCATION OF BUSINESS ADDRESS IF DIFFERENT FROM MAILING ADDRESS

 IMPORTANT: Last year you reported the property shown below.                                                                          HOW TO REMOVE AN ITEM:
 1. Please draw a line through items youdid NOT own on                        Jan. 1st, 2023 .
                                                                                                                                               
 2. List ANY items NOT SHOWN in this box in the areas below or attach additional sheets.                                                        EXAMPLE                

                                                                                 Please add VIN if missing from items shown in this box.  Add 
                                                                                 VIN to any newly purchased items you list below or on back. 
                                                                                 This 17-digit number can be found on your insurance card.
           Please place an      in one of these boxes after completing front and back of form.  Sign before returning.
                               X CHANGES HAVE BEEN MADE                                           X NO CHANGES MADE
                               Items were added, deleted, or address was changed                  No new items owned on Jan. 1st
   Sign & Return this ORIGINAL form along with asset listings to the Assessor’s Office.
           To save time, you may submit a copy of your amortization schedule along with your signed form.
Attention! Under each category below enter the total cost (rounded to the nearest dollar) of all assets of like kind that were acquired in the year indicated at left. The amount you enter 
in each box should be the combined total original cost for all property of the same kind acquired that year. Refer to the CLASS LIFE SCHEDULE below for examples of how to classify 
assets based on their expected life. If you need another account set up, or help filing, please call (417) 868-4892. If additional space is needed, please list on a separate sheet.
    3 Year Recovery Period  (See below for Class Life Schedule)                         7 Year Recovery Period  (See below for Class Life Schedule)
 Purchase Year                   100% of Acquisition Cost       % Good             Purchase Year     100% of Acquisition Cost                                           % Good
    2022                                                     75.00% x 33.33%            2022                                                                           89.29% x 33.33%
    2021                                                     37.50% x 33.33%            2021                                                                           70.16% x 33.33%
    2020                                                     12.50% x 33.33%            2020                                                                           55.13% x 33.33%
   2019 & prior                                                5.00% x 33.33%           2019                                                                           42.88% x 33.33%
                                                                                        2018                                                                           30.63% x 33.33%
    5 Year Recovery Period  (See below for Class Life Schedule)                         2017                                                                           18.38% x 33.33%
 Purchase Year                   100% of Acquisition Cost       % Good              2016 & prior                                                                       10.00% x 33.33%
    2022                                                     85.00% x 33.33%
    2021                                                     59.50% x 33.33%
    2020                                                     41.65% x 33.33%
    2019                                                     24.99% x 33.33%
   2017 & prior                                              10.00% x 33.33%

 Class Life Schedule:  Purchases apply to the following IRS Cost Recovery Tables as specified in RSMO 137.122. Refer to the following class life schedule.  Depreciable Assets - illustrative  
 sample not intended to be a complete list.  IF YOU ARE UNSURE WHAT RECOVERY  PERIOD APPLIES TO YOUR PROPERTY, PLEASE CONSULT YOUR TAX PROFESSIONAL OR THE 
 IRS/MACRS TABLES FOUND AT http://www.irs.gov.  
 CLASS:                        Special tools and devices used in manufacturing of rubber, plastic, glass, motor vehicles, foundry, and primary steel or fabricated metal products such as dies, jigs, molds, patterns, 
 3 Years   fixtures, or gauges.
 5 Years   Information systems, computers, adding machines, calculators, copiers, telephone central office switching equip., computer-based construction equipment, timber-cutting  
           equipment, manufacture equipment used in production of knitted goods, carpets, textile yarn, apparel, chemicals, electronics, nonferrous metals, and boats. 
 7 Years   Office furniture, fixtures, files, communication equipment, printing or publishing equip., transmitters, receivers, antenna structures, cooling systems, control equipment, satellite  
           equipment, equipment used in the production of beverages, furniture, pulp & paper, rubber, plastic, primary steel, metal, mechanical, aerospace products, jewelry and other goods.
 10 Years  Telephone central office equipment switching & related equipment, manufacturing equipment used in the production of grain, feeds, flours, cereals, sugar, vegetable oil and etc. 
 15 Years  Manufacturing equipment used in the production of concrete, bulldozers, unloaders, bobcats, ditchwitch, cell towers, etc.  

                                                             CONTINUED ON BACK                                                                  GREEI2-102 (Rev 11/22} 039B



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Any new improvements to Real Estate in the past year?  (Check appropriate box)    9 New Building                                             9 Remodeling    9 Additions      Other9
   (DO NOT LIST      YEAR   MAKE(Chev, Ford)         MODEL(Impala, Focus) SERIES(SL, SE)           # DOORS# DRV WHEELS(Circle)     TONS      CAB TYPE(Circle)             VIN                 (Vehicle ID Number)
LEASED VEHICLES)
                                                                                                                 2WD    4WD    AWD           REG   EXT  CREW
AUTOS, VANS
SUVs, JEEPS                                                                                                      2WD    4WD    AWD           REG   EXT  CREW
   PICKUPS
HISTORIC VEHICLES                                                                                                2WD    4WD    AWD           REG   EXT  CREW
                                                Submit a copy of the Missouri mileage form for reciprocity to be applied.
                     YEAR                 MAKE                      MODEL  / TYPE                  GVW                 MO MILES              TOTAL MILES                                      VIN (Vehicle ID Number)
    SEMI
 TRACTORS
                     YEAR            MAKE / MODEL              TYPE (Reefer, Flat, Van, Tanker, Etc.)        AXLES     LENGTH     MO MILES        TOTAL MILES                                 VIN (Vehicle ID Number)
    SEMI
   TRAILER

COMMERCIAL           YEAR   MAKE (Chevy, Ford)         MODEL  / TYPE      BED TYPE                 AXLES     GVW              ADDITIONAL EQUIP. COST                                          VIN (Vehicle ID Number)
                                                                                                                              (excluding Cab & Chassis)
   TRUCKS
(List Semi-Tractors
    Above)
MOTOR HOMES,         YEAR                 MAKE                         MODEL & SERIES                        TYPE (Circle One)                  LENGTH                                        VIN (Vehicle ID Number)
CAMPERS & RVs                                                                                      5TH WHEEL     UPRIGHT     FOLD DOWN
    (Including 
PERMANENT TAGS                                                                                     5TH WHEEL     UPRIGHT     FOLD DOWN
   TRAILERS          YEAR                 MAKE                 TYPE (Stock, Flat, Boat, Horse,     HITCH (Circle One)            AXLES WGT/TON       LENGTH                                   VIN (Vehicle ID Number)
                                                                    Cargo, Enclosed, Utility)
    (including                                                                                          GOOSENECK      BUMPER
BOAT TRAILERS & 
PERMANENT TAGS)                                                                                         GOOSENECK      BUMPER
                     YEAR            MAKE / CHASSIS                            MODEL / SERIES                                 LENGTH       # PASSENGERS                                       VIN (Vehicle ID Number)
    BUSES
MOTORCYCLES, YEAR                         MAKE                           MODEL                     # OF WHEELS                TYPE (Circle One)      CC                   VIN (Vehicle ID Number)
   ATVs & UTVs                                                                                                            MC        ATV        UTV
 (Mules, Gators, 
    Rangers)                                                                                                              MC        ATV        UTV
                     YEAR            MAKE                      MODEL                         TYPE (Riverboat, Bass, Jon)         MATERIAL (Circle)   LENGTH                                   VIN / SERIAL NUMBER
   BOATS &                                                                                                                    Fiber   Alum.   Wood
   BARGES
                                                                                                                              Fiber   Alum.   Wood
 AIRPLANES           YEAR             MAKE                   MODEL & SERIES           MAX. CERTIFIED GROSS       (Circle One) HOURS FLOWN       PURCHASE PRICE                                VIN / SERIAL NUMBER
                                                                                         TAKEOFF WEIGHT                           LAST YEAR
(Including Historic                                                                                              COMMERCIAL
    and Kit)                                                                                                 NON-COMMERCIAL                     $
GRAIN/HAY            Bushels on Hand,
   For Resale        Stored or Sealed:       Corn __________      Soy Beans __________       Wheat __________       Milo __________       Oats __________       Other: _____________________________
                     Calves (300-600 lbs.)          No.             Sows/Boars        (400 lbs.)   No.                 Slaughter Lambs (120 lbs.)No.                Horses/Colts                          No.
 LIVESTOCK           Yearlings (600 lbs. & over)    No.             Barrows/Gilts     (250 lbs.)   No.                 Replacement Ewes (150 lbs.)No.               Chicken/Poultry                       No.
                     Cows/Bulls                     No.             Pigs (90 lbs.)                 No.                 Feeder Lambs (80 lbs.)        No.
   PORTABLE          YEAR             WIDTH x LENGTH         PURCHASE PRICE              LANDOWNER                                                                        HOW LONG AT THIS LOCATION?
   STORAGE                                                   $
 BLDGS/SHED
                     YEAR                 MAKE               WIDTH x LENGTH                                         LOCATION:
   MOBILE
   HOMES             Do you own                        If not, please
                     real estate that                  list land owner:
                     home sits on?         YES       NO
                            * List Construction Machinery / Heavy Equipment / Farm Machinery purchased during the last year.
   MACHINERY                 DESCRIPTION                     YEAR              MAKE                          MODEL                4X4             HP ENGINE (circle)      YR. PURCHASED                PURCHASE PRICE
*      &                                                                                                                          YES    NO          Gas     Diesel                                    $
    OTHER                                                                                                                        YES    NO           Gas     Diesel                                    $
   EQUIPMENT                                                                                                                     YES    NO           Gas     Diesel
                                                                                                                                                                                                       $
                     YR. ACQUIRED          ACQUISITION COST             ASSESSOR USE                                     LEASED BUSINESS PERSONAL PROPERTY SUMMARY
   LEASED            2022                                                                          Please list below any leased or rented equipment in your possession.  The terms of your lease 
 EQUIPMENT           2021                                                                          or rental contract may determine tax liability. This section is designed to ensure that the property 
                     2020                                                                          is assessed to the proper owner.  You may wish to attach a separate list or a copy of your lease.
                     2019                                                                          Item:
                     2018                                                                          Date of Lease:                 
                     2017                                                                          Lessor’s Name,
                     PRIOR YEARS                                                                   Addr. & Phone #:
Enterprise Zone: If your facility is located in an Enterprise Zone, please provide a list showing acquisition date by year and cost for tools and equipment used for pollution 
control, and for tools and equipment used in retooling to introduce new product line or to make improvements to an existing product line. 
List your Standard Industrial Classification (SIC) code: ___________________________________________

 APARTMENTS             Apartment/Motel Owners Only:     Address of Apartment/Motel:  ________________________________________________________________________________
    MOTELS                                                                    Please List Total Number of Furnished Rooms: ______________________ __________

 SHORT TERM             Address of Short Term Rental: __________________________________________________________________________________________________________
    RENTALS             # of Bedrooms:______________________   # of Bathrooms: ______________________

Reciprocity: Companies involved in interstate trucking must submit list of road equipment and a copy of the Missouri Mileage Registration Form If they want reciprocity to be 
applied. Please specify length on trailers for proper assessment. 
Unsigned or incomplete forms: An unsigned or incomplete assessment list cannot be accepted and will be returned for completion.
Extensions: With a written request received by March 1st, you may receive an extension until May 1st.
AGENT OR PREPARER’S NAME (Please Print)                                                                ADDRESS (NOT a P.O. Box)

CITY, STATE, ZIP                                                                                                 TELEPHONE                                  EMAIL ADDRESS                     
                                                                        (Please
I, ___________________________________________________________________,   Print) 9 President     9 Treasurer     9 Owner     9 Manager     9 Other ___________________________
of  __________________________________________________________________,  do hereby certify that the foregoing list contains a true and correct statement of all the tangible personal property made taxable by the 
laws of the state of Missouri, which I owned or which I had under my charge or management on the first day of January, 2023. I further certify that I have not sent or taken or caused to be sent or taken any property 
out of this state to avoid taxation. Any person who refuses to make the certification to the list, when required so to do by the assessor or the assessor’s deputy, shall upon conviction be deemed guilty of a misdemeanor 
and no property shall be exempt from executions issued on judgments in prosecutions pursuant to this section.

SIGN               HERE                                                                                                DATE:                                   Federal Tax ID:   

                                                                                                                                                                                              GREE2 - 102 (Rev 11/22)   039B






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