DAVID COX - ASSESSOR(816) 858-3312

MARK THROUGH ITEMS YOU NO LONGER OWN. ADD NEW PURCHASES OR TRANSFERRED-IN ASSETS IN SECTIONS 4 & 5.

AFTER REVIEWING/UPDATING THE FORM, PLEASE CHECK THE APPROPRIATE BOX BELOW.

3 YR CLASS YEAR 5 YR CLASS YEAR 7 YR CLASS YEARYEAR ACQUIRED COST % ASSESSOR USE ONLY ACQUIRED COST % ASSESSOR USE ONLY ACQUIRED COST % ASSESSOR USE ONLY

75.00 85.00 89.2937.50 59.50 70.1612.50 41.65 55.135.00 24.99 42.88

10.00 30.6318.3810.00

CLASS: 3 YRUse this Class for Pallets, Special tools and devices used in themanufacturing of food & beverages, rubber, plastic, glass, and fabricated metal products, as well as special tools such as dies,jigs, molds, patterns, fixtures, or gauges used in the manufacture of motor vehicles. This class does not apply to restaurant equipment, computers, video games or movies. A list may be required.

CLASS: 5

YR

Information systems, computers, high tech medical equip, adding machines, calculators, copiers, telephone, computer based central office switching equip, heavy construction equip, timber cutting equip, manufacturing equip used in production of knit goods, carpets, textile yarn, chemicals, electronics, nonferrous metals, and boats. Wholesale and retail sales & services. Radio & broadcasting equipment except transmitting towers and videos.

CLASS: 7 YR

This class includes office

sign here

PRINT NAME DATE

SECTION 1: BUSINESS ACCOUNT INFORMATION

DATE NAME CHANGED ACCOUNT NAME CHANGE

NEW MAILING ADDRESS

CITY ST ZIP

DATE MOVED

PROVIDE PHYSICAL ADDRESS IF DIFFERENT THAN MAILING ADDRESS

DBA

(Complete if different than legal name)

LEASED/DRIVER INFO OR LESSEE (If applicable)

EMAIL

DAYTIME PHONE

SECTION 2: BUSINESS INFORMATION

IS THIS A MULTIPLE LOCATION? YES NO If yes, please give the number in Platte County and list the locations below.

NEW BUSINESS: DATE OPENED DATE BUSINESS CLOSED DATE BUSINESS SOLD SOLD TO IF YOU REPORT UNDER A DIFFERENT NAME, LIST HERE

MAIL David Cox - Assessor 415 3rd St., Rm. 115, Platte City, MO 64079

SCAN & EMAIL businesspersonal@co.platte.mo.usFILE ONLINE 1. Go to www.plattecountyassessor.net2. Click on Business Personal Property3. Enter PIN found to the right

REVIEW AND MAKE CORRECTIONS BELOW IN BLUE OR BLACK INK

(Name should be true corporate/legal name)

CITY TAX TYPE

Missouri State Statute 137.280:

CHECK ONE OF THE FOLLOWING THAT BEST DESCRIBES YOUR BUSINESS:

UTILITIES WAREHOUSING

LODGING #RMS

RETAIL

CONSTRUCTION AUTO REPAIR RESTAURANT

PROFESSIONAL & TYPE:

OTHER, PLEASE EXPLAIN:

NO CHANGES I HAVE CHANGES/ADDITIONSCheck if items listed in Section 3 are not complete, accurate, or you have addednew assets to Section 4 or 5. If you have changes to listed assets, cross them out above and put the corected amount in Section 4 or 5.

CONTINUE ON BACK SIDE

BUSINESSPERSONAL PROPERTY

PLATTE COUNTY ASSESSMENT LIST 2015

DECLARATIONS NOT RETURNED TO THE ASSESSOR’SOFFICE BY MARCH 1, 2015 WILL BE SUBJECT TO PENALTY.

RETURN BY MARCH 1, 2015

2015

CHILD CAREFUNERAL HOMEGROCERY STORE

DATA CENTERSOLELY HOME BASED

TRANSIT DISTRIBUTION BANKSALON: HAIR, NAIL, TANNING OR MASSAGE

NOT FOR PROFIT, PLEASE EXPLAIN:

201420132012

20102009

2011 & Prior

2008 & Prior

SECTION 3: BUSINESS ASSETS PREVIOUSLY REPORTED IN 2014

SECTION 4: BUSINESS ASSETS - 2015

All tangible business property owned or held in Platte County as of January 1, 2015 must be reported . Dollar amounts in all schedules must reflect 100% of the original cost - less freight, tax & installation - rounded to the nearest whole dollar. NO ATTEMPT SHOULD BE MADE TO FILE ASSESSED VALUES; this will be determined by the Assessor’s Office. A separate return must be filed for each

business location. If you need another account set up, or help filing, please call (816) 858-3312. If additional space is needed, list on a separate sheet or in an Excel spreadsheet.

Check if items listed are EXACTLY the same for 2015. DO NOT CHECK IF NOASSETS ARE LISTED ABOVE. LIST ASSETS IN THE APPROPRIATE SECTIONS.

furniture, fixtures, files, communication equip., medical and dental office equip.(except high tech equip.), restaurant equip., forklifts, tools(including hand tools), printing or publishing equip., transmitters,receivers, antenna structures, cooling systems, control equipment, satellite equip., equip. used in the production of beverages, furniture, pulp & paper, rubber, plastic, primary steel, metal, mechanical, aerospace products, jewelry and other goods.

COST OF SUPPLIES ON HAND JANUARY 1, 2015 NOT HELD FOR RESALE X 33.33%

**TAXPAYERS ARE REQUIRED TO EITHER FILL OUT, SIGN AND RETURN OUR ORIGINAL FORM OR FILE ONLINE**

I hereby certify that the foregoing list contains a true and correct statement of all the tangible business 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. I further certify that I have not sent or taken or caused to be sent or taken any property out of the state to avoid taxation in the State of Missouri.

(Required)

CONSTRUCTION

ACCT NO:PIN:

10 YR CLASS YEAR 15 YR CLASS YEAR 20 YR CLASS YEAR

YEAR ACQUIRED COST % ASSESSOR’S USE ONLY ACQUIRED COST % ASSESSOR’S USE ONLY ACQUIRED COST % ASSESSOR’S USE ONLY92.50 95.00 96.2578.62 85.50 89.0366.83 76.95 82.3556.81 69.25 76.1848.07 62.32 70.4639.33 56.09 65.1830.59 50.19 60.2921.85 44.29 55.77

15.00 38.38 51.31

32.48 46.8526.57 42.3820.67 37.92

15.00 33.46

29.0024.5420.08

20.00

CLASS: 10 YR

switching & related equipment (FCC), manufacturing equipment used in the

cereals, sugar, vegetable oil, etc., vessels, barges, tugs, and similar equipment unless used in marine construction.

CLASS: 15 YRManufacturing equipment used in the production of concrete (see 32.2). Cell towers and windmills.

CLASS: 20 YRTelephone communication buildings intended for housing of central

production plants. Refer to Asset Classes: 40.51,40.53, 40.54, 49.11, 49.13, 49.14, 49.21, 49.221, 49.3, 49.4, and 51.

RETURN TO: David Cox - Assessor, 415 Third St., Room 115, Platte City, MO 64079

AUTOSVANSSUVsJEEPS

PICKUPS

YEAR MAKE (CHEV, FORD) MODEL (IMPALA, FOCUS) SERIES/TRIM PACKAGE (SL, SE/WT, LTZ, LARIAT, KING RANCH) VIN #DOORS #DRIVE WHEELS

(CIRCLE) TONS CAB TYPE(CIRCLE)

2WD 4WD AWD 1⁄2 3⁄4 1T REG EXT CREW

2WD 4WD AWD 1⁄2 3⁄4 1T REG EXT CREW

2WD 4WD AWD 1⁄2 3⁄4 1T REG EXT CREW

2WD 4WD AWD 1⁄2 3⁄4 1T REG EXT CREW

HEAVYTRUCKS &

SEMI TRAILERS

YEAR MAKE TYPE LENGTH VIN MO MILES TOTAL MILES GVW #AXLES TONS

BUSES & MOTOR HOMES

YEAR MAKE/CHASSIS BODY NAME MODEL/SERIES VIN LENGTH #PASSENGERS (BUS)

CAMPER TRAILERS

YEAR MAKE MODEL LENGTH VIN TYPE (CIRCLE) #AXLES

UPRIGHT FOLDOWN 5TH WHEEL

UPRIGHT FOLDOWN 5TH WHEEL

TRAILERS (Including BOAT

TRAILERS)

YEAR MAKE MODEL/TYPE(UTILITY, FLATBED, STOCK/HORSE, BOAT) VIN HITCH/TYPE (CIRCLE)#AXLES LENGTH

GOOSENECK BUMPER

GOOSENECK BUMPER

GOOSENECK BUMPER

BOATS(PERSONAL

WATERCRAFT& MOTORS)

YEAR MAKE MODEL/TYPE (JON, BASS, JET, PONTOON)

FIBER, WOOD, ALUMINUM LENGTH VIN BOAT MOTOR

FUEL TYPE START TYPE MAKE TYPE YEAR CYL/HP

G D E ELECTRIC MANUAL OB I/O IB /

G D E ELECTRIC MANUAL OB I/O IB /

G D E ELECTRIC MANUAL OB I/O IB /

MOTORCYCLESATVs

YEAR MAKE MODEL CCs VIN TYPE (2, 3 or 4 WHEELER)

AIRPLANEYEAR MAKE MODEL SERIES ENGINE

(SINGLE, TWIN) VIN MAX. CERTIFIED GROSS TAKEOFF WEIGHT

HOURS FLOWN/YR

COMMERCIAL(CIRCLE)

YES NO

FARM MACHINERY

&HEAVY

EQUIPMENT

DESCRIPTION (TRACTOR, COMBINE, PLOW, DRIER, BALER, RAKE, BRUSH HOG, MIXER, BULLDOZER, BACKHOE, FORKLIFT, BUGGY, SAWMILL)

YEAR PURCHASED YEAR MANUFACTURED ACQUIRED COST 4 X 4(CIRCLE)

CAB(CIRCLE)

DIESEL(CIRCLE)

YES NO YES NO YES NO

YES NO YES NO YES NO

YES NO YES NO YES NO

MOBILE HOMES

(MANUFACTURED HOME USED AS

RESIDENCE)

YEAR MAKE MODEL VIN WIDTH LENGTH

IF MOBILE HOME PARK

NOTE: DO NOT LIST YOUR MOBILE HOME IF YOU OWN THE LAND

PARK NAME & ADDRESS PHONE LOT NO.

CONTACT PERSON

LEASED EQUIPMENT

YEAR ACQUIRED ACQUISITION COST ASSESSOR’S USE ONLY LEASED PERSONAL PROPERTY SUMMARY

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 is assessed to the proper owner. You may wish to attach a separate list or a copy of your lease.

LESSOR’S NAME AND ADDRESS:

LENGTH OF LEASE: ITEM:

DATE OF LEASE: ORIGINAL COST:

If located in the Enterprise Zone answer 1, 2 and 3: 2. Cost of tools and equipment used in retooling to introduce new product line or to make improvements to an existing product line.

1. Cost of tools and equipment used for pollution control. YEAR ACQUISITION DATE COST PRODUCT LINEYEAR ACQUISITION DATE COST $

$ $$ $$ $$ $$ $$ $$ $$

NAICS:

SECTION 6: POLLUTION CONTROL/RETOOLING/CLASSIFICATION

20142013

201220112010200920082007 2006& Prior2005

20042003 2002& Prior200120001999 1998& Prior

SECTION 4: BUSINESS ASSETS - 2015 (CONTINUED)

SECTION 5: BUSINESS PROPERTY - 2015