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Any new improvements to Real Estate in the past year? (Check appropriate box) M New Building Remodeling M Additions M OtherM
(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)
AUTOS, VANS SUVs, 2WD 4WD AWD REG EXT CREW
JEEPS, PICKUPS 2WD 4WD AWD REG EXT CREW
HISTORIC VEHICLES
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 YES NO list land owner:
home sits on?
* 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 2021 Please list below any leased or rented equipment in your possession. The terms of your lease
or rental contract may determine tax liability. This section is designed to ensure that the property
EQUIPMENT 2020 is assessed to the proper owner. You may wish to attach a separate list or a copy of your lease.
2019
2018 Item:
2017 Date of Lease:
2016 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 # _________________________________
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.
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) M President M Treasurer M Owner M Manager M 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, 2022. 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.
DATE: Federal Tax ID:
SIGN HERE +
GREE2 - 102 (Rev 10/21) 039
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