HomeMy WebLinkAbout20032594.tiff 18283
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(Rev. 10-98) Identifying number
i�Name(s)shown on your income tax return 4 6 6-6 4-9 9 8 0
/ Albert S . Challenger L
Section B — Appraisal Summary — List in this section only items(or groups of similar items)for which you claimed a deduction of
more than$5,000 per item or group.Exception.Report contributions of certain publicly traded securities only in Section A.
If you donated art, you may have to attach the complete appraisal.See the Note in Part I below.
Matt-44 Information on Donated Property — To be completed by the taxpayer and/or appraiser.
4 Check type of property: Gems/Jewelry Stamp Collections
_Art*(contribution of$20,000 or more) Real Estate —
Art*(contribution of less than$20,000)
Coin Collections Books Other
_
*Art includes paintings,sculptures,watercolors, prints,drawings,ceramics,antique furniture, decorative arts,textiles,carpets,silver, rare
manuscripts, historical memorabilia, and other similar objects.
Note: If your total art contribution deduction was$20,000 or more,you must attach a complete copy of the signed appraisal.See instructions.fused fair
5 (a) Description of donated property(if you need (b) If tangible property was donated,give a brief summary of (c)
) Appraised
overall h sical condition at the time of the gift market value
more space, attach a separate statement) the P y 183000
A 12 Acres
B
C
D See Instructions
(d) Date acquired (e) How acquired (f) Donor's cost (9) For bargain sales, (h) Amount claimed (I) Average trading
as a deduction price of securities
by donor(mo.,yr.) by donor or adjusted basis enter amount received 183000
A 09-30-1999Purchase 10228
B
C
[tt:11}l Taxpayer (Donor) Statement — List each item included in Part I above that the appraisal identifies as
having a value of$500 or less.See instructions.
I declare that the following item(s)included in Part I above has to the best of my knowledge and belief an appraised value of not more than$500
(per item). Enter identifying letter from Part I and describe specific item. See instructions. P.
Date ►
Signature of taxpayer(donor) ►
"p; nil Declaration of Appraiser
I declare that I am not the donor,the donee, a party to the transaction in which the donor acquired the property, employed by,or related to any of
the foregoing persons,or married to any person who is related to any of the foregoing persons.And,if regularly used by the donor, donee,or party
to the transaction, I performed the majority of my appraisals during my tax year for other persons.
Also, I declare that I hold myself out to the public as an appraiser or perform appraisals on a regular basis; and that because of my qualifications
as described in the appraisal, I am qualified to make appraisals of the type of property being valued, I certify that the appraisal fees were not based
on a percentage of the appraised property value. Furthermore,I understand that a false or fraudulent overstatement of the property value as
understa understatement of taax liability).a I affirm th this
atappraisal
I havesnot summary
ba barred from presenting ev subject me to the idence or testimony by the der section Director of Pract and ice.
the
Sign (' U��2 [ [y� 099
► ea' Date of appraisal ►
Here Signature In�/ , f�� � �� `' Identifying number
Business address(including room or suite no.) �,i/�08(j bed 33230 South Holland Street 7
City or town,state, and ZIP code
LakewoodCO 80226
Mifflin?" Donee Acknowledgment -- To be completed by the charitable organization.
This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated
property as described in Section B, Part I, above on ►
(Date)
Furthermore,this organization affirms that in the event it sells,exchanges,or otherwise disposes of the property described in Section B,Part I (or
any portion thereof)within 2 years after the date of receipt, it will file Form 8282,Donee Information Return,with the IRS and give the donor a copy
of that form.This acknowledgment does not represent agreement with the claimed fair market value. ► Yes No
Does the organization intend to use the property for an unrelated use?
Name of charitable organization(donee) Employer Identification number
Weld County Colorado 84-6000-813
Address(number,street,and room or suite no.) City or town,state,and ZIP code
915 10th Street Greeley, CO 80631
Aut n signature
Title David E. Long, Chair Date QA4f7 Board of Weld County 9/04/2003
V1( r anon
nna
CAA 9 828312 NTF 17522 "'(2922
Copyright 1999 Greatland)Neico LP-Forms ttware Only 2003-2594 .PLIS-ry3
PL1573
2003-2594
CD Located in File
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