HomeMy WebLinkAbout911020.tiff . I 15-DPT FOT 'RESCRIBED BY THE PROPERTY TAX ADMINISTRATOR WELD COUNTY flPREC'Sin>
FORM 920 1/66-6/90 PE. JN FOR ABATEMENT OR REFUND OF TAXES—C. F. .,.�EcueL RaP10.4. r- y
`'IILrIcI4iiI /; �`'I1
Petitioners: Use this side only. I I
u.; a ds1'., , J
Greeley , Colorado, June 19, 91 �
City or Town Crrrtry,G;'::+_n
To The Honorable Board of County Commissioners of Weld County
Gentlemen:
The petition of Gerrity Oil & Gas Corporation (formerly The...Rabe.rx..G.e.r.r..ity...Carparly
whose mailing address is. c/o Logan & Firmine,, Inc. P.O. Sox 4274
Englewood Colorado 80155
City or Town State Zip Code
SCHEDULE NUMBER DESCRIPTION OF PROPERTY AS LISTED ON TAX ROLL
0 0159790 Bernhardt 1-3
respectfully requests that the taxes assessed against the above property for the years A. D.
1990 , 19 , are erroneous, illegal, or due to error in valuation for the following reasons:
(Completely describe the circumstances surrounding the Incorrect value or tax.)
Original Original Original Corrected Corrected Corrected
Reported Reported Assessed Volume Value Assessed
Volume Value Value Value
435 Bbls 6618 5790 211 Bbls 3687 3230
6121 MCF 9294 8140 2333 MCF 3768 3300
13930 6530
The original 1990"Oil and Gas Real and Personal Property Declaration Schedule" was
reported in error. It included sales from November and December 1988 which were
previously reported on the 1989 Declaration Schedule.
1990 19 `
Value Tax Value Tax
Orig. 13930 $1161.48
Abate. 7400 617.00
Bal, 6530 544.48
The taxes (have) (101WiatA) been paid. Wherefore your petitioner prays that the taxes may
be abated or refunded in the sum of $ 617.00
I declare, under penalty of perjury in the second degree that this petition, together with any
accompanying exhibits or statements, has been examined by me and to the best of my knowledge,
information and belief is true, correct and complete.
Gerrity Oil & Gas Company
JPetiti�oner
BY / 45i-
Agent
Richard D. Logan
Address P.O. Box 4274
�
Englewood, CO 80155
Q./ t w t) U
4r}/ c,c As,),, 1 K f c, ii,,,„ n i o zo
RESOLUTION OF COUNTY COMMISSIONERS
WHEREAS, The County Commissioners of Reid County,
State of Colorado, at a duly and lawfully called regular meeting held on the 12th day
of August , A.D. 19 91 , at which meeting there were present the following
members. Chairman Gordon E. Lacy_, and Commissioners George Kennedy_, Coaatance...l.
Harbert, C.W. Kirby, and W.H. Webster
notice of such meeting and an opportunity to be present having been given to the taxpayer and
the Assessor of said County and said Assessor.,...reptesertted...hy..aozothy.Allen,and taxpayer
representative, Richard Logan, not being present; and (name)
(name)
WHEREAS, The said County Commissioners have carefully considered the within applica-
tion, and are fully advised in relation thereto,
NOW BE IT RESOLVED, That the Board c.nncurs with the recommendation of
(concurs or does not concur)
the assessor and the petition be.aPproved „ and an abatement/refund be allowed
(approved or denied) (be allowed or not be allowed)
on an assessed valuation of$ 13,930 for $ 1161.48 .total tax for the year(s) 19 90
C a(r an of o County Commissioners.
STATE OF COLORADO, l
Weld 1 ss.
County of 1
I, Donald D. Warden, Clerk to the Board, azazstaletluandaDoofitekiattattc
of the Board of County Commissioners in and for the County of Weld
State of Colorado, do hereby certify that the above and foregoing order is truly copied from the
records of the proceedings of the Board of County Commissioners for said Weld
County, now in my office.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said County,
at Greeley,, Colorado, , this 12th day of gu,
, D. 19.-9.1...
County Clerk.
By d
Deputy.
ACTION OF THE PROPERTY TAX ADMINISTRATOR
Denver, Colorado, , 19
The action of the Board of County Commissioners, relative to the within petition, is hereby
❑ approved; ❑ approved in part $ ❑ denied for the following reason(s)
ATTEST:
v
Secretary. ,:, Property Tax Administrator.
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GREE�012.. Co*::e,g0J j OIL AND GAS E 11
itLU •
REAL AND PERSONAL PROPERTY Assessment Date Due Date
•
DECLARATION SCHEDULE
County CONFIDENTIAL DATA January 1 April 15
MAIL TO COUNTY ASSESSOR YOU MUST FILE EVERY YEAR REGARDLESS IF ANY AD
• DELETIONS WERE MADE. ADDITIONS OR
B.A.CODE T.A. CODE SCHEDULE NUMBER
CHANGE OF NAME ANTI/OR ADDRESS
0013341
A. NAME AND ADDRESS(INDICATE ANY CHANGESI
GERR.IIV APi»ERT if CCIIPANY 711:'' _ DO NOT USE - FOR ASSESSOR ONLY
Bernhardt 1'-3 % Low' 6 r- I F ti f t E j n t Code — Description #O� _Actual
`* �---- --
1yELL5 $ ctua� I Value y. Assessed Value
71 Primaryf'rod.
8787'/S$
P A :10.X 42:74i
.10446410017CO (3U i i i 7i Secondary Prod. 75
- --`
LOCATION OF PROPERTIES OR LEGAL DESCRIPTION 72 Improvements "'
-- — 29
• C sw/4 SW/4 i 47 74 EquIp• turn& _
Mdclrblery 29
TOTALS $ $
• RECEIVED gppROVEO
LEASE NAME OR DESCRIPTION
COMPLETED_ ABSTRACT CHGS.
LATE FILING PENALTY APPLIED YE5 NO❑
B. Dete;Business Stgrted�� Typs of product or Service
•STATUE OF PApPERrted., laeaa Check the A tin County) Corp,❑ Partnership ppropriate Box) Is this the ❑ Individual ❑ Other CI
NEW BUSINESS OR-: first return? L__I Yes ❑ No Neme and Address of Previous Owners:
❑ NEW OYUNER(9) IYbu MUST ATTACH a complete ltemlied listing of ell your property.)
PLEASE'1NOlCrgTE THE LIFE OF THE OIL'AND GAS FIESERVE IN YEARS UNDER THE CURRENT PRODUCTION RATE
C. PRQ!?UCT1bN.REPORT FOR PREVIOUS YEAR -_YRS.
C1 PRIMARY:PRODUCTION
U- A g FOR ASSESSORS USE ONLY
:Field Name Wi11 N sold er C —`^D E F--_ — __G_�
l I Total Flared, Avgy Prlee A— ilowed NO;. Transported Vented or At Well Head Vslue-• Actual
:'' t Produced From Used On or Field
Product Rey ally
ti;!=i' �-- -- __Prem its _ Lease Price (9 x CO) Exclusion Value
Bad 435 15.2I7_��� (t�st,.x.nspl) - IE x P)
f f.. ..•:.:;...;
: a MCF __ - _-6 618 — — — --
�, BBL • MCF �9 294 -_ -_
�. !;y MCF /bbl —.
BBL /MCF
MCF /bbl '_` _
• :•;:;:,•:i:,. • • ' Totals Totals Totals /MCF ---�_
7otais —"—To'tbls
CZ. SECONDARY,:TERTIARY OR RECYCLING RECOVERY PRODUCTION
Method : ::: _ FOR ASSESSORS USE ONLY
of • Weil U A B C _ p .� E
•• • Field Name No. N Total '3of• °r `PisieB` —7011r we
Recovery Ave�ce —7i llowe• ~_
I Produced Tram
omted Vented or Ai Well Head gud 'l Royyaity Aaluei
T Premises Usad On or Field Product Exeluslen Value
Lease �EHoe (B x D)_1t•y. ) (E x F)•
BBL
. . . . . . . . . MCF /bbl
_86_L /MCF —"_____
/bbl
—"—`
MCF
BBL /MCF �--� -
MCF —' /bbl -
•
�;) t -/MCF --- - - �_.:..
a t,• : , Totals Totals Totals _ -- _ -"---
D. �.7; .. . ;;,.,1•'' :' ':. Totals Totals
EXCLUDABLE ROYALTIES
Excludable royalty amounts are limited to the fractional interest owned by the Federal Government, the State of Colorado,counties, cities,
towns, municipal corporations, tribal councils or other government oryaniietions within the State of Colorado.
Well, • '
No. Leave Name Or Number Name Of Governmental Entity Royalty%
Exempt From
Taxation
' ---
•
—..
—____ _-.
91.1`l.1.102114 Ili'I .,n' t'in''
______ . ... ...�,�„1 ,1„„��,i.r .r, i•v
_ ...
WILL WELL lit ..—_—.__.—.. . .. _..
DEPTH or
PIHLD pOriMA/'toil r TnC"sE AVENADECLOWRAIE
NO. LEASH NAME DEPTH
.sECOVErlY E .ACTED (BBL or MCP/DAY)
_. 73Q0_. __ Jenver(U-.11 0il._-- 1.19 _
Gas_.. ------ -- -- 16.77
Water Minimal
F. LISTING OF REAL PROPERTY IMPROVEMENTS (Attach a separate sheet if necessary(
aelldinp.Fixtures end Leasehold Improvements Description and Location pair nr InflMled Cml Atltllllons amen Orl9lnel
hmlallen on installation
G. LISTING OF PERSONAL PROPERTY
Furnish a complete listing of all property.Additions mul deletions may Inn lislnd iI a complete listing has been previously filed with the assessor.
Item Ouerlpllon Medal nr Ynar Date Acgulretl PHohrol Esllmnrnd C nPacllY Mfg. --�IJew Uled em MNM-noel Eflhneln nrinabiniy
)__..__—" Plydral Vfelul I.IIe
(1) List Personal Property acquired during previous year. (Attach se rm ate sheet it necessai y,) Gm d condition Its Year,
Flnwing Gas Wp11 with Tanks _ ______ _ _ 4177 Minimum
Assessed Vitlue 1150
111 LjSt Personal Property sold.traded. or permanently disuosed of dul Pig u evious Ye_I.(Alloc Il•seuar ate s e i71-necessary.)
(3) List ALL Mobile Equipment. Attach separate s(,cei i II ecessar .
i
NOTE: The cost, description and year acquired data must be furnished above for those fully depreciated assets still in use.
H. DEPRECIATION SCHEDULE (Fundgh hllonnnlion no Attach most emu ant Copy of Federal opplacierlorl Schedule,
a. Oroup end guideline elan b. Dale e, cnsl or d. DePrenlellnn e. Method of or dnarlPllen e/PrepeHY eeeulnd other balls plowed m elloweble numputhng /. Lite or e• Depreciation for
In prior years depredation rate this yeas
S
CON of other fully depreciated assets still In use. $ Total deprecledon
I. LEASED, LOANED, OR RENTED PROPERTY (Furniture, Signs, Etc.) (Declare Property Owned By Others Here.)
Did you have In your possession on January 1st any leased, loaned,rented machinery,equipment,or furniture, fixtures,signs, vending
machines, etc.? ❑ YES O NO If yes, list below showing description of this property and name and address of owners.
Name and Address of Owner/Lessor baserlpllon Model/Serial No. Yam Current Coot or
Mfg. GSA List Price Year Im411ad Total Yearly Rarsl
Please furnish details of purchase or maintenance options. (Attach a separate sheet 11 necessary)
J. PURCHASER'S STATEMENT
List names and add I purchasers of oil and gas products. Attach sepmale sheet II necessary.
Name — —___..---.__— —.___—__. ---_--_— I
Address__________________
ddress quantity
K. DECLARATION Tii1S RETURN IS iiii3JECT TTUAWI't.
"I deelere,under penalty of perjury In the second denten.Ihnl this schnduln,inonlhet will,nny eccotnpgnying exhibits ur natenumis,has been examined by
me and to the best of my knowledge.Inlmirnilml,nod belle!,sots forth a lull nail rnunplein 11,1 nl MI Menhir pommel properly nwnnd by me or ifs my posses"
don,or under my control, located in title county Cuhondn on Ibn eNBa n'nl dnln of IhN ynnr:Ilml such IllOpelly h
as been value fairly represented:and that no attempt I en do to told I dsrt p . sir ns In its nee,qunlity,<tumidly or value" CI1S131-6°1071 described and Its
SIGNATURE OF OWNER On AGENT" "'s.'L�eEC_/U.
NAME OF OWNER The Robert Gerrity Company____ ��/o PRINT NAME OF PERSON SIGNING R irbard�,_Lo.yan g Tax_Re._.resentative UATr-
p — PHONE APRIL 1 (303) 771-5511
PLEASE COMPLETE_____ANU IIE'I UIIN"rO 311E ASSESSOR UN on BEFORE APRIL 15
nu. 1900 TAX NOTICE hLML LJ 1 p 1 L NI,C Vial M. I USIA l I ..
FRANCIS M. IDUSTALE7
21354-C LEASEHOLD INT S. lW4 1 4 67 WELD COUNTY TREASURER
( BERNHARDT 1-3) GERRITY COMPANY INC THE P.O. BOX 458 GREELEY,CO 80632-0458
PHONE: 356-4000 SCHEDULE
EXT 4453
0 0159790
VALUATION VALUATION TOTAL LEVY 1ST HALF 500.74
LANG IMPS.OR PER. VALUATION 2ND HALF 580.74
TOTAL 1 . 161.48
0 13930 13930 83.379
5
PARCEL 105901000040 03 PIN 0 0159790 01ST 0518
GERRITY ROBERT W COMPANY THE
TOTAL
% LOGAN S FIRMINE INC AMOUNT
P U BOX 4274 COLLECTED
ENGLEWOOD CO 80155 PAID BY
I
Office Copies IF YOU NEED OUR RECEIPT PLEASE CHECK HERE
SCHEDULE 0 0159790 DETACH FOR voun RECORDS PARCEL NUMBER
COUNTY OF WELD, STATE OF COLORADO
TAX DISTRICT 0518 1990 TAX NOTICE 105901000040 03
TAX AUTHORITY LEVY TAX DUE DATES
WELD COUNTY 22.209 309.37 General property taxes are due
SCHOOL DIST RE5J 45.704 636.66
January t of each year
NCW WATER 1 .000 13.93 .
CCW WATER 1 .212 16.90 FIRST HALF - Delinquent alter
' CGS WATER 1 .993 27.76 last day of February
MILLIKEN FIRE 3.842 53.52
AIMS JUNIUR COL 5. 918 82.44 SECOND HALF - Delinquent after
1WEL❑ LIBRARY 1 .500 20 .90 last day of July
APPROVED 7 FULL AMOUNT - Delinquent alter
last day of April
FOR PAYMENT IF LOAN COMPANY IS RESPONSIBLE FOR THIS
Date �/�3�9 TAX. RETAIN THIS BILL FOR YOUR FILES.
I C;;3!1 & Firmine. Inc.
83.379 1 .161 .48 WITHOUT STATE AID THE SCHOOL PROPERTY GENERAL 125 .971
lAM MILL LEVY WOULD HAVE BEEN -
Tax Payer Copies IMPORTANT SEE REVERSE SIDE
fSum4a. of Gross o. 1nn.l 6a.s Sa ICs Ffoot 4.76c/inc..
r1 ..,:.•!, trok a. O3/41
(.1 VGA -F0 Wm, Cc.re'-f y Durir, -fhc Ptrooct .lanuary t88-,anuafy 485 •
O, I ISct Ls C1ac__ISa.1eS
1
6rosr bo lump , Gross Vo,..luc Gross VoiumE Gross Va.1 uo.
— -____ _____�-8b_I5l _ (mrts) —
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G _....4...._ __ S/88 __. .1 I !.._.1.'I O 410 ..... 118 412;S _ ..... .12.1110 ...._ _.._ i jr3 6.t9..3 93..
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-- - "--. _. •air ----
•
OGCC FORM 10 FOR OFFICE USE ONLY
• Rev.9/87 • STATE OF COLORADO
OIL AND GAS CONSERVATION COMMISSION IETI LFEI IUCI ISEI
DEPARTMENT OF NATURAL RESOURCES I Ir
CERTIFICATION OF CLEARANCE AND/OR CHANGE OF OPERATOR
•OGCC LEASE NO. LEASE NAME WELL NO. . API NO.
sill Aeiexrym T l -_3 os O3 /a9ve
FIELD/pi NAME i NO. ,7/. ?Olt
COUNTY LOCATION
/ 7� LOCATI/ONN(1/4 V..SEG�JWp.RNGJ / T N p y
1.241-FTOR NAM SERS IOlt�n GO C k J OGCC OPR. St /7 Je_� • 1 E PHONE NUMBER/\ 6,1/ W
BA-S/Al FXPApiPllTio/t) JNC., 0005yo 13ARE00301 0a3-3/oo
• STATE ZIP CODE
1'/. al� AR1MLAl.W re . SUE 7F 300 '*-1-. day iti-I Co. kr; sa s
• PREVIOUS RAT f EFFECTIVE DATE OF CHANGE
*Complete only Fh this el-ypart Pa ytAciv producing lease. 3ff 7o) ip -/7- Er?
**Complete only If change of operator.
PRODUCING FORMATION(S) (A separate FORM 10 TYPE OF COMPLETION
must be submitted for each producing formation a a ❑ NEW COMPLETION ❑ COMMINGLED COMPLETION
Multiple Completion.) ❑ RECOMPLETION . ❑ MULTIPLE COMPLETION
New Well Test Data on 24 hr. Basis:.
Bbls.Oil Mcf Gas Bbls.Wtr.
I
OIL TRANSPORTER (Purchaser) GAS GATHERER (Purchaser)
NAME OGCC NO. NAME OGCC NO.
ADDRESS ADDRESS
1 CITY STATE ZIP CODE CITY STATE ZIP CODE
AREA CODE PHONE NUMBER DATE OF FIRST PRODUCTION AREA CODE PHONE NUMBER DATE OF FIRST SALES
1 1 1 1
ROYALTY OWNER METHOD OF WATER DISPOSAL
❑ STATE ❑ FEDERAL ❑ CENTRAL PIT ❑ COMMERCIAL PiT
O INDIAN. - ❑ PATENTED ❑ ON-SITE PIT ❑ INJECTED
NUMBER OF ACRES IN LEASE
❑ N/A
Remarks:
The undersigned certifies that the rules and regulations of the Oil and Gas Conservation Commission of the State of Colorado
have been complied with except as noted above and that the transporter(s)is(are)authorized to transport the oil and/or gas
produced from the above described well and that this authorization will be valid until further notice to the transporter named
herein or until cancelled by the Colorado Oil and Gas Conservation Commission- -
OGCC Approved: 5.J4M C�+D 7
N• w Print) Ar
�� i _
Signature Signature
TheAAJl&AA} ,) -aa -8- 9
roe Oats Title Dateq.9110+y
I •
Mt£dPit-Allid4Nr7dike6tfloiE ;SOI?I S 01 .CI: State of Colorado 1989
,y2S 1fTH STREET OIL AND GAS
AREtfLH.Y, co aciii3t REAL AND PERSONAL PROPERTY Assessment Date Due Date
NF'LD ' DECLARATION SCHEDULE
County - CONFIDENTIAL DATA January 1 April 15
MAIL TO COUNTY ASSESSOR YOU MUST FILE EVERY YEAR REGARDLESS IF ANY ADDITIONS OR
. DELETIONS WERE MADE.
•
B.A.CODE . T.A.CODE SCHEDULE NUMBER CHANGE OF NAME AND/OR ADDRESS
s131t calfi x;' , 13341 c/o Logan & Firmine, Inc.
A. NAME AND ADDRESS(INDICATE ANY CHANGES) P.O. Box 4274 —
•
_ Englewood, CO 80155
_ _UU F_NU I Ubb — UH ASSLSSUH UNLY
GERR.IYY ROBERT.
O BI:RT. ,N CDfIPANY THE code Description Acres Actual Value % Asssssed Value
BERNHARDT 1.x3 ' • 7110 Primary Prod. $ 87%$
C/0 Logan & Firmine, Inc. 7120 Secondary Prod. 75
— P.O. Box 4274 _
Englewood, CO 80155
LOCATION OF PROPERTIES(INDICATE ANY CHANGES OR ADDITIONS) 72 Improovements 29 ,
. . 74 MiGiiiOelvrn.a& 29
C GM4$W4 1 4 67
TOTALS $ $
RECEIVED APPROVED
LEASE.NAME OR LEGAL DESCRIPTION COMPLETED ABSTRACT CHGS. i
. LATE FILING PENALTY APPLIED YES j'1 NO❑
ti
B. Date Business Started Type of Product or Service (in County) Corp.❑ Partnership❑ Individual ❑ Other ❑ •
it Name and Address of Previous Owners: ,
STATUS OF PROPERTY (Please Check the Appropriate Box)
❑NEW BUSINESS OR ❑NEW OWNER ISI(You MUST ATTACH a complete itemized listing of all your property. '
1. Is this the first return?. ❑ Yes ❑ No
C. INVENTORY OF WELLS
Total No.Wells • indicate Whether Well No. Type Depth Year Drilled
1 You Are:
Total No;Acres : ili�Operator of the Leese
List Fractional Interest of ❑Owner of the Leasehold
Operator 100 % ❑Owner of the Lend ,
'.PLEASE INDICATE THE LIFE OF THE OIL AND GAS RESERVE IN YEARS UNDER THE CURRENT PRODUCTION RATE YRS. ''
I%- 0. PRODUCTION REPORT FOR PREVIOUS YEAR Furnish primary production in section D-1 and secondary production in section D-2
Dt. PRIMARY PRODUCTION OR RECOVERY
Total Transported from Ro all�yy De iv red Ro Il9 Dallvaretl Total Taxable Av a e
Produced ost . Premises unsoltl qyf Oa h 1pnpY As rOd Yuel On1Y Price •I eatl
lA) (B) lC) IExe,Dllon) (Exe1E�lon) (Eferclor E) or�ied rice
031
•Well No. Oil (Bbt ) • 1,502. ( 1 502 $15.2698 /bbi
Gas (MM. 26,161 Tex b 26; 161 $1 .4261 /MCF :
• Well NP - eyeYa Comptrtdtilm• 60 240 $ /bbl
. .OII ((list ). Tennt.Gra a-Value $ 062 $ /MCF
Gas:(MCF.) : I PSc rye"Wt-RDyalty $ —
weu No. *Oil (Bbla. GV After f x. Royalty g 60,240 $ /bbl
Gas'(MCF) .''. . . Total Auf sled Vaiva $ 52,710 $ /MCF
: 02.SECONDARY,TERTIARY OR RECYCLING METHODS OF PRODUCTION OR RECOVERY
Well No. O(I(Bbl.) $ /bbi
Gas (MCF) $ /MCF
Well No. , Oil (Bbl.) $ /bbl
Gas(MCF) $ /MCF
Weil No. Oil (Bbl,) $ /bbl
_
Gas (MCF) $ /MCF
03. METHOD OF SECONDARY,TERTIARY OR RECYCLING RECOVERY, (i.e.water injection, CO2 injection, etc.).
Well No. _. Well No. Well No.
E. ASSESSMENT EXEMPTIONS REQUEST: (Attach separate sheet if necessary.)
Exemptions are limited to the fractional interest owned by the Federal Government,the State of Colorado,counties,cities,towns,municipal
corporations,tribal councils or other government organizations within the State of Colorado!
Name of Government Fractional
Lease No.S.Legal Description Organization Owning Interest Address Interest Owned
•
Total Prdduetlon: I Exempt: 'Taxable: I S/Barrel or MCF:
(see other side.) 21.102()
..gg ®® nFll.IIIN THIS COPY
F. LISTING OF REAL PROPERTY
List below or attach a separate sheet listing buildings, fixtures and leasehold improvements constructed or installed the previous year. This
list shall include the description and location of the property, the date of installation, the original installed cost, and any additions since
original installation.
Buildings,Fixtures and Leasehold Improvements Description and Location Data
Installed Cost Additions Since Original
installation Installation
G. LISTING OF PERSONAL PROPERTY SEE ATTACIIED
Furnish a complete listing of all property.Additions and deletions may be listed i a complete listing has been previously filed with the assessor.
Item Modal or Year Date Acquired original Estimated
No, pescrlpUon Capacity Mfg. New I Used Installed Cost Estimate
Remaining
Condition Useful Life
(1) List Personal Property acquired during previous year. (Attach separate sheet if necessary.) In Years
(2) ,.ist Personal Property sold,traded, or permanently dispofed of during previous year. (Attach separate sheet if necessary_j
(3) List ALL Mobile Equipment. Attach separate sheet if necessary,
•
NOTE: The cost, description and year acquired data must be furnished above for those fully depreciated assets still in use.
H. DEPRECIATION SCHEDULE (Furnish Information or Attach most current Copy of Federal Depreciation Schedule)
a. Group and guideline class b. Date c. Cost or d. Depreciation a. Method of f. Life or g. Depreciation for
or description of property acquired other basis allowed or allowable computing rate thls year
in prior years depreciation
Cost of other fully depreciated assets still in use. $ Total depreciation
i. LEASED, LOANED, OR RENTED PROPERTY (Furniture,Signs, Etc,) (Declare Property Owned By Others Here.)
Did you have in your possession on January 1st any leased, loaned, rented machinery,equipment, or furniture, fixtures, signs, vending
machines, etc.? ❑ YES ❑ NO If yes, list bel0w'showing description of this property and name and address of owners.
Name and Address of Owner/Lessor Description Model/Serial No. Year Current Cost or Year Installed Total Yearly Rent
Mfg. GSA List Price
Please furnish details of purchase or maintenance options.
J. PURCHASER'S STATEMENT
List names and addresses of purchasers of oil and gas products. Attach separate sheet if necessary.
Name Address Quantity
K. DECLARATION THIS RETURN IS SUBJECT TO AUDIT.
"I declare,under penalty of perjury In the second degree,that this schedule,together with any accompanying exhibits or statements,has been examined by
me and to the best of my knowledge,inforrnation,and belief,sets forth a lull and complete list of all taxable personal property owned by me or in my posses-
sion, or under my control, located in this count in Colorado on the assessment date of this year; that such property has been reasonably described and its
value fairly represented;and that no attempt s een made to n head a assessor as to its age,quality,quantity or value." CRS 39.6.107( }
SIGNATURE OF OWNER OR AGENT -4.e---.6-Zit-"e-e7 -•/ �-
NAME OF OWNER The Robert Gerrity Co pinny DATE
(//74C'
PRINT NAME OF PERSON SIGNING_Rlf harS) n ( Qgan s TdX RapreSP.11tr7t]YE—_PHONE NUMBER (301) 771-i51_j,_
rl t'ASF COMP' GTE,SIGN AND RETURN TO 1Iir oSSUSSOft ON on tlFFORF APRIL r�
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