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5(#8S
Owner Name:
_________________________________________
Account Number: ___________________
Part 5: General Description of Plant Assets.
A.
Total Investment as
of January 1, 2017
B.
Retirements during
year 2016
C.
Additions during
year 2016
(optional)
(optional)
(optional)
D.
Total Investments
as of January 1,
2017 (A-B+C)
(optional)
E.
F.
G.
Accrued
Maintenance and Owners's good faith
Depreciation as of Repair during 2016 estimate of market
January 1, 2017
value *
(optional)
(optional)
H.
Original Cost
(optional)
I.
Date
Acquired
(optional)
Buildings and Structures
Site and Yard
Improvements
Machinery and
Equipment Fixed in
Place
Totals
Construction work in process
Total Construction in process as of January 1, 2017 (optional)
Owner's good faith estimate of market value for work in process of January 1, 2017
Part 6: Plant Assets in your possession that are owned by others. (attach additional sheets if necessary, identified by business name, account number, and "Part 6).
A.
General Description
B.
Location of Assets
*If "Over $20,000" is checked in Part 4 and original cost is not provided, the chief appraiser may later ask you to
provide a supporting statement detailing the basis for your good faith estimate of market value.
C.
Owner's good
faith estimate
of market value*
D.
Property owner name/address
(if you manage or control the property as a fiduciary)
Page 2
Totals
2017 Rendition
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