HomeMy WebLinkAbout970467.tiffrUHM 920 (68-93)
PETITION FOR ABATEMENT OR REFUND OF TAXES
Must be filed In duplicate and alt questions must be answered.
�a-q 7-063
9
Petitioners: Complete this side only.
Englewood , Colorado,
an«ram
July 24
, 19 96
lb The Honorable Board of Commissioners of Weld County
Gentlemen:
The petition of Patina Oil & Gas Corporation (formerly Gerrity Oil & Gas Corp.)
whose mailing address is: c/o Logan & Firmine, Inc. 333 W. Hampden Ave., #740
Englewood
Oty a Tam
SCHEDULE NUMBER
Parcel # 121316000001
PIN # 0064892
Colorado 80110
swe nv cue.
DESCRIPTION OF PROPERTY AS LISTED ON TAX ROLL
Megan H 16-03, 16-04, 16-05, 16-06
c-)
respectfully requests that the taxes assessed against the abovepropertyfor the ,
8 yews A. D:
19 94 , 19_, are erroneous, illegal, or due to error in valuation for the following reasons:
Describe specifically the circumstances surrounding the incorrect value or tax, including owner's
estimate of value. (Attach additional sheets if necessary)
Sales of other wells were reported
with the Megan wells when original
returns were filed.
See Attached
Orig. 452,970
A atc176,880
276,090
19 94
Value
$49,456.62
19,312.30
$30,144.32
$ 97,220.82 Oil Value
263,384.53 Gas Value
$360,605.35 Total
45,075.67 Less Exempt Royalty 12.5%
$315,529.68 Actual Value
87.50% Assessment Ratio
$276,088.47 Assessed Value
19
Value
mx
Therefore the petitioner requests that the taxes may be abated or refunded in the sum of $ 19,312.30
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.
Patina Oil & Gas Corporation
By
Z‘.07(6,1/141 --"--
Address
c/o Logan & Firmine, Inc.
333 W. Hampden Ave., #740
Englewood, CO 80110-2337
(0Daytime phone number 303-761-8260
Dab
Every petition for abatement or refund filed pursuant to section 39-10-114 shall be acted unon nursuant
to the provisions of this section by the board of county commissioners or the assessor, as appr //50032
six months of the date of filing such petition. 39-1-113(1.7), C.R.S. 970467
�� /15) re -t, rkinPf-
RESOLUTION OF COUNTY COMMISSIONERS
Section 1: In accordance with 39-1-113(1.5) C.R.S., the commissioners of
County authorize the assessor to review petitions for abatement or refund and to settle by written mutual
agreement any such petition for abatement or refund in an amount of one thousand dollars or less per tract,
parcel, or lot of land or per schedule of personal property.
County Commission Resolution #
The assessor and petitioner mutually agree to an assessed value of $ for
$ total tax for the year(s) 19_ and an abatement/refund of $
Petitioner', Signature Date
Assessor'e Signature Date
4 - t..
I
If Section I is not complete and/or If petition is for more than $1,000, Section II must be completed.
Section II: Assessors's recommendation:
10 approved; 0 approved in part $ 0 denied for the following reason(s)
Petitioner is correct in contention that Gerrity Oil and Gas Corp
over reported the value of oil and gas.
2/6/412z,
By:
Dep. Assessor
WHEREAS, The County Commissioners of Weld County,
State of Colorado, at a duly and lawfully called regular meeting held on the 10th day
of February , A.D. 19 97 , at which meeting there were present the following
members: chair Conrge E. Baxter and Commissioners Dale K. Hall, Constance L.
Harbert. Barbara J. Kirkmever, 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 Warren T acol t and taxpayer
Patina 041 6 Gac C;rn ration (name)
im being present; and
WHEREAS, The said County Commissioners have carefully considered the within application, and
are fully advised in relation thereto,
NOW BE IT RESOLVED, That the Board concurs with the recommendation of
(concurs ordon rill concur)
the assessor and the petition be an roved , and an abatement refund be allowed
I.paowad d chilled) lea allowed or nd be sllwnd)
on an assessed valuation of $ 176.880.00 for $ 19.312.30 total tax for the year(s) 19 94 ,
«= / 2 r
cMtr en of Board of County Commissioners
STATE OF COLORADO,
County of we i d
I, Donald D. Warden , County €2I:-7tkxaitthtitafafticia Clerk of the
Board of County Commissioners in and for the County of We l d
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 We l d
County, now in my office.
IN WITNESS WHEREOF, I have IIetgun .` t my hand and affixed the seal of said County,
at crooloy , this . day Act, A.Q. 1997
ill' a"rkto the Board
/.
ACTION OF THE PROPERTY TAX ADMINISTRATOR
s/ wry
oapr+tyC 1 k to the Board
Denver, Colorado, w.'7 _ 199 %.
on of the Board of County Commissioners, relative to a within petition, is hereby
approved in part $ 0 denied for the following reason(s)
Properly Tax Administrator
�vn AL UU 11LU lU'aJ
r UJ
WELD COUNTY ASSESSOR AUDIT
1993 OIL SALES DETAIL
MEGAN H 16-3 4 5 & 6 Bbls
urc aser tatements S's
01/93 384.64 6,552.47
02/93 421.48 7,634.81
03/93 626.16 11,558.05
04/93 513.68 9,513.86
05/93 802.31 10,971.71
06/93 424.14 7,319.93
07/93 617.30 9,832.96
08/93 413.23 6,598.55
09/93 413.15 6,367.08
10/93 645.49 10,437.43
11/93 414.74 6,095.97
12/93 350.33 4,338.00
Total Purchaser Statements 5,826.65 97,220.82
Declaration Statements
Megan H 16-3
Megan H 16-4
Megan H 16-5
Megan H 18-6
Total Declaration Statements
Under/(Over) Reported
4,974.91
1,316.26
1,593.36
1,945.04
85,907.67
21,089.88
26,569.15
33,636.32
9,829.57 167,203.02
(4,002.92 (69,982.2O
Jun -LC -d0 wCu 1J.�l
P. 07
MEGAN H 16-3, 4, 5 & 6
urc aserStatements
01/93
02/93
03/93
04/93
05/93
06/93
07/93
08/93
09/93
10/93
11/93
12/93
GERRITY OIL & GAS CORPORATION
WELD COUNTY ASSESSOR AUDIT
1993 GAS SALES DETAIL
Mcf.
$'s
13,774 28,803.63
9,460 17, 558.16
13,245 24,169.73
13,496 24,983.74
12,770 25,516.84
12,210 20,570.70
11,754 19,890.27
11,516 19,911.07
10,158 19,465.40
11,235 21,136.56
10,714 20,675.97
9,911 20,702.46
Total Purchaser Statements 140,243 263,384.53
Declaration
Megan H
Megan H
Megan H
Megan H
Statements
16-3
18-4
16-5
16-6
Total Declaration Statements
Under/(Over) Reported
156,229.62'
18,362.57
20,470.43
32,274.48
292,341.84•
34,339.32
38,606.14•
59,149.18
227,337.10' 424,436.48-
87 094.10 ,J161,051.95
O
O
0
REAL ESTATE
z
a
0 0064892
— I V V
vs or.
Mn
O CO
N N
es
hh
N N
49,456.62
11.
et et
XX JQ
.0 I-
-4. N 0
DIST 01 B9
N
P
r
O
O
0
2
00
Ea
8
40.
oa v 0
z v
r
N W
6 Z
U' is
r S
04 0:
o
00 44,0
.4> 2a pX O
ww SEW
N•¢ J0d
IWL M0W
N
N
r
O
m
V --- l -F -F s -- 1
0
W 0 20
_ _ • N W
V J a
W i ' • a0 r
2 0 LL W
2
WtI� W r a w w
<W O Co JO
W 20 .• cc O>
&Z0 > W r
FJ O 5'5 l - ] N a
6W O -' W 2 0
U¢ w W Z a cc a
oaN0 Q �m
W a
x N
U r
>Z 0 w d 1- > S
► m0 O W 2 W 2 F
�< •. z '•i' ¢ az
Lilz r
a8 z 042
tin -
c, �— ii € • N z a
O• Q
O s
§6 - J X
r O 2 • Q
E W 1-
O E
r
LL
rO
w
a
N
d
W
3
U.
0
z
o
U
_
�_• r d •-•
2
0
00
Co O
W •
0: M
W
0:JQ
>a
>w
J V
ro
2
>
as
or
= W
W =>
r
• K
X
I-
• O e N r e m
• aria O 0 0 @
P Of hhhe.a
a o N O
r r
♦9,456.62
W
J
O O t 0 0 0 0
M O h M 0 0 0 0
Oooh00r0O
• • • • • • • •
N 0 r r r 0 r 0
NM f
M
•
0•
0
O
N
Ni
0:w.
W.
cc!
0.
0
a
2
TAX AUTHORITY
0
r a
a V W > S
T. XXX
.0.042
Z 7 O W W W Z W a
V0 J C C J,O
J
s
00 4000
JIZOOMJW
MOUVJ 12 0
a
• Q -- •slaccoNce 1
J
Q
0
0
r
PAUt 1 or 1
5199
1.5DPr-AS Font, DS -658 e1 w
MAIL To WELD COUNTY ASSESSOR
1400 N. 175, Ave. Greeley, CO 90831
Phone: (300) 353-3845
YOU MUST
State of Colorado
OIL AND GAS 19 94
REAL AND PERSONAL PROPERTY Assessment Date Due Date
DECLARATION SCHEDULE January 1 April 15
CONFIDENTIAL DATA
(One Well per Schedule)
FILE EVERY YEAR REGARDLESS IF ANY ADDITIONS OR DELETIONS WERE MADE
0185 PARCEL NUMBER 8SEC 121316000001 04 OIL PIN NM 0064892 PERSPIN ?MR 0018247-73
A. NAME AND ADDRESS (INDICATE ANY CHANGES)
GERRITY OIL 6 GAS CORPORATION
CHANGE OF NAMEAND,OR ADDRESS
3 LOGAN 6 FIRMINE INC
P 0 BOX 4274
ENGLEWOOD, CO 80155
NAME AND ADDRESS OF PREVIOUS OWNER(S)
B. STATUS OF PROPERTY PROPERTY LOCATION OR LEGAL DESCRIPTION:
11445-0 LEASEHOLD INT NW4 16 3 65
LEASE NAME OR DESCaPION:FIELD MEGAN 416-2202a 0''1I50(, 6 06
1{
Is NB &st Return? YES NO
API* NAME. COGCC I: DrCTE COMPLETED:
your
0512315112
—New Wee—NewOenegs)
C. PRODUCTION REPORT FOR THE PREVIOUS YEAR - Check valuation method used.
R Actual Wellhead Price —Unrelated Party Netback (Producer) —Comparable Price Used to Value PROCESSORS Leasehold
DUCER'S 4�whold Related Party Netba& (Pmdtrsr mcaSSor
—Comparable Price USed W Value PRO —
ci.P78fAARYPiwoucTlON ATTACH REPORT OF TIK OWNERS 6 VS
FOR ASSESSOR* USE ONLY
UNIT
TOTAL PRODUCED
(SHOIAD RECONCILE
TO Marx -FORM)
FLARED, VENTED.
OR USED ON THE
LEASE
A. SOLD OR
'TRANSPORTED
FROM LEASE
B. TOTAL VALUE
RECEIVED FOR
THE WELL SITE'
ALLOWED
FOYALTY
EXCLUSION
ACTUAL
VALUE
BBL
4,9/4.91
85.907.67
MCF
156,229.62
292,341.84
t :E W4S P.E t:::'
17 27
_--t--Ri P: LW
TOTALS
Taut Vak a may be wrrPsrsd to COGCC loom a reported Web. Gam Volts", reported at 14.73 PSI - Industry sWMard, wnaat r'rrtr'1' Y pressure S Merslit
C2.SECONDARYPRomlCTION -ATTACH REPORT OF TIK OWNERS 6 VS
BOX'B' by aWl'M per
FOR ASSESSORS USE ONLY
UNIT
TOTAL PRODUCED:
(SHOULD RECONCILE
TO C FORM)
FLARED. VENTED,
OR USED ON THE
LE SE
A. SOLD OR
TRANSPORTED
FROM LEASE
8. TOTAL VALUE
RECEIVED FOR
THE WELL SRE•
ALLOWED
FOYALTY
E%CLUS ON
ACTUAL
VALUE
BBL
Bpi gB pylpad pbyy B9MppCF
WILMA •
ysppa0rr 8e8eL�
s MCF
TOTALS
'Total Veka may be compared to COGCC forma reported totals. Gas Vahnne reported at 14.73 PSI • Mushy standard. contact COGCC 8 pressure is different
D. EXCLUDABLE ROYALTIES - Excludable royalty amounts are limited to the fractional interest owned by the Federal Government, the State of
Col do unties cities towns municipal corporations tribal councils or other government organizations within the State of Colorado.
ore , co
None of Government Envy
Royalty X Exsn
From Taxationpt
State Board of Land Commissioners
12.50%
E. PURCHASER'S STATEMENT - List names and addresses of purchasers of oil and gas products. Attach separate sheet if necessary.
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. Information. and ballet. sets forth a full and complete list of all taxable personal property owned by me or in my possess ion. or under my control, located In this county in
Colorado on the meet date of this year; that such property has been reasonably described and Its value fairly represented; and that no attempt has been made to mislead the
assessor as to Its age, quality, quantity or value? 39-5-107(2)CR
`44-..-04 ` ‘_ DATE r//46 303-771-5511
SIGNATURE OF OWNER OR AGENT
PRINT NAME OF PERSON SIGNING Richard D. Logan. TaX Rep. NAME OF OWNER Crinril & Gas orporat on
PLEASE COMPLETE, SIGN, AND RETURN TO THE ASSESSOR ON OR BEFORE APRIL 15 (INSTRUCTIONS ON OTHER SIDE)
RETURN THIS COPY
I'Mlat G Ot
5Zv
i0 DPT-AS Form DS -6513 91 94
MAIL To WELD COUNTY ASSESSOR
1400 N. lTh Ave. Greeley, CO 30831
Phone: (303) M1Aavu5
YOU MUST
BA CODE 51311 TA CODE
State of Colorado
OIL AND GAS
REAL AND PERSONAL PROPERTY
DECLARATION SCHEDULE
CONFIDENTIAL DATA
(One Well per Schedule)
FILE EVERY YEAR REGARDLESS IF ANY ADDITIONS OR DELETIONS WERE MADE
0185 PARCEL NUMBER if SECT 121316000001 04 OIL PINNBR 0064892 pp,Rsp01NBR 0018247...70
A. NAME AND ADDRESS (INDICATE ANY CHANGES)
GERRITY OIL 6 GAS CORPORATION
CHANGE OF NAME AROyOR ADDRESS
% LOGAN 6 FIRMINE INC
P 0 BOX 4274
ENGLEW00Dg CO 86155
B. STATUS OF PROPERTY PROPERTY LOCATION OR LEGAL DESCRIPTION:
NAME AND ADDRESS OF PREVIOUS OWNER(S)
11445-0 LEASEHOLD INT NM4 16 3 65
LEASE NAME OR DESCRIPTION: MEGAN_ H16-03 04 05 6 06
FIELD NAME: WELL NAME AND NUMBER / _
AP*COOCC I. DATE WELL4O:
la V* your Brat Return?ES _NO
0512315112
—New Wee —New Owners)
C. EQUIPMENT INVENTORY LISTING
Cl. WELL CHARACTERISTICS A 8 %Jf(91ilk ixnirzfal'ilx
mum NAME DFLILES BURG ID —J/ wpm 7340 CLASS(Meck any OIL GAS _ COAL SEAM GAS
C2. METHOD OF PRODUCTION - Check where applicable. AHW 1f11pbU11lXKnMHtrXX%X X
SECONDARY WELL TYPE: _SUPPLY _DISPOSAL— CO2 INJECTION _WATER INJECTION TANKS INSTALLED-- x ON SITE _ COMMON TANK BATTERY
MOTOR TYPE_ GAS _ ELECTRIC _ESP wen pawns owns
C3. INSTALLED EQUIPMENT- Innate der number of each on location. OVERALL EOWMENT CONDRION(CHECK ONE): _VERY GOOD XAVERAGE — MINIMUM
COUNT OF: _LS TANKS _s TANKS IN COMMON TANK BATTERY _*PROCUCTION UNIT(S) ISEPARA'TOR(S)—SHEATER TREATEA(S) SOEHYDRATOR(S)
Based on year of manufacture. check dw average age of installed went* equipment. Years
Has any installed well she undergone a main overnsul In the leer Area MINT— NO_ YES
If yes. Meese desert* Molt the Noe of overhaul. and the adahonal years of ere�r life added wthe eWMIwiL Attach aeWraw sheet PneasWV
METHOD OF LIFT. _FLOWING _PUMPING _ PLUNGER UFT
19 94
Assessment Date Due Date
- January 1 April 15
DESCRIPTION OF EQUIPMENT
DESCRIPTION OF MAJOR OVERHAUL
YEARS ADDED
C4. AMOUNTS OF PRODUCTION
OIL I9 75 BBL GOBI 1rt.29 MCF WATER
BBL DAYS CAPABLE OF PRODUCTION a STRIPPER WELL? _Yes _IC No
NT . Indicate the number of each ern IocatIon. (Attach additional Mornized Wog 1 needed)
EQUIPMENT DESCRIPTION downs woe eta ewes Redo Telemetry Lea Corals Protection this win Reeler or Soler Asset Der MMr Runt Mine Kars.
Pros INeyew Plop. OM Saes line Compressor tar NP)
DDANIITY
CONDITION
LAN tap, amriN nt
-
JAN — AVG —POD
J.1IN — AVG _VOD
—MIN — AVG —POD
EQUIPMENT DESCRIPTION
CONDITION
MAKE
MODEL
SUE OR FOOTAGE
YEAR MFG.
JAN _AVG VOD
--MIN — AVG VOD
_JAN _AVO —VW
'
ASED, LOANED, OR RENTED PROPERTY (DeDweprwertyowned bym IM Or Oath Win%Moot)
NAME AND ADDRESS OF OWNERILESSOR
DESCRIPTION
MODEUSERIAL NO.
TERM (Prom -To)
ANNUAL RENT
DECLARATION
THIS RETURN IS SUBJECT TO AUDIT
'I declare undo 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, information, and belief, sets forth a full and complete list of all taxable personal property owned by me or In my possession, or under my control, located In this county in
Colorado on the asssssmenl date of this year; that such property hajkgn reasonaby des p ad and Its value fairly represented; and that no attempt hes been made to mislead the
assessor as to Its age, quality, quantity or value.39-S-107(2)CR
SIGNATURE OF OWNER OR AGENT
PRINT NAME OF PERSON SIGNING
PLEASE COMPLETE, SIGN, AND RETURN TO THE ASSESSOR ON OR BEFORE APRIL 15 (INSTRUCTIONS ON OTHER SIDE)
RETURN THIS COPY
ridiV
DATE
PHONE
NAME OF OWNER
HAlit 1 of 2
52D1
IS OPT -AS Form D
sane, a State of Colorado
OIL AND GAS 19 94
ASSESSOR REAL AND PERSONAL PROPERTY Assessment Date Due Date
DECLARATION SCHEDULE January 1 April 15
CONFIDENTIAL DATA
(One Well per Schedule)
YOU MUST FILE EVERY YEAR REGARDLESS IF ANY ADDITIONS OR DELETIONS WERE MADE
.ill 0185 PARCEL NUMBER 83E0 121316000001 04 OIL PIN NBR 0064892 PERS PIN NBR 0018247702
Greeley, CO 80831
353-3845
MAIL lb WELD COUNTY
1400 N. 17th Ave. O
Phone: (003)
SA Cwt + a TA CCOE
A. NAME AND ADDRESS (INDICATE ANY CHANGES)
CHANGE OF NAME AND/OR ADDRESS
GERRITY OIL C GAS CORPORATION
% LOGAN C FIRMINE INC
P 0 BOX 4274
ENGLEW000F CO 80155
NAME AND ADDRESS OF PREVIOUS OWNER(S)
B. STATUS OF PROPERTY PROPERTY LOCATION OR LEGAL DESCRIPTION:
11445-0 LEASEHOLD INT NW4 16 3 65
LEASE NAME OR DESCRIPTION: MEGAN H16-03 04 05 i 06
X.NO
FIELD NAME: WELL NAME AND NUMBER:
la_dQ Ut your Ant Return? ..—YES
API* COGCC e: DATE'*tLAOMPLETED:
0512315115
—New Wel —Nev Owner(*)
C. PRODUCTION REPORT FOR THE PREVIOUS YEAR - Check valuation method used.
_xActual Wellhead Price _Unrelated Party Netback (Producer) —Comparable Price Used to Value PROCESSOR'S Leasehold
Comparable Price Used to Value PHODUUtH'b Lassen=la —run.... w.... any "o...........
CI PRIMARYPRODUCTION —ATTACH REPORT OF TIK OWNERS 5 i S
' OR ASHL6fOR,B
USE ONLY
UNIT
TOTAL PRODUCED.
(SHOULD
S TO COGCC FORM)
FLARED. VENTED,
OR USED THE
A. SOLD OR
F� LEASE
B. TOTAL VALUE
RECEIVED FOR
THE WELL SITE'
ALLOWED
FOYALT7
EXCLUSION
ACTUAL
BBL
1,316_26
71,089.88
MCF
18.362.57
34.339.32
Box 'B' Divided by Box W .
16' �21 Der egte TOTALS
Boalu boYepa-w. ^-.w.•^a•
TOW Value may compared to Milne form S reported totals. Gore Volume reported at 14.73 PSI - edueey s1 4e d, contact COGCC A preen'" le dlfemt
CI SECONDARY PRODUCTION ATTACH REPORT OF TIK OWNERS i VIS
FOR ASSESSOR'S
USE ONLY
UNIT
TOTAL PRODUCED'
(SHOULD
TTOOGCRECONCILE)OR
FLARED, VENTED.
USED ESE THE
A. SOW OR
TRANSPORTEFROM LEASE D
B. TOTAL VALUE
THE LLDSIITTEE'
ALLOWED
YALTV
ER XCLUSION SION
ACTUAL
VALUE
BBL
MCF
Box 'B' Divided bv Box •A• .
f Per BBL
TOTALS
_
eon 'B'DIuMM by t'A'.
Top Value may be compared to COOCC form B reported Iwo. Gas Volume reported at 14.73 PSI - Industry standard, contact COOCC F pressure is different.
D. EXCLUDABLE ROYALTIES - Excludable royalty amounts are limited to the fractional interest owned by the Federal Government, the State of
tl t Ib I ccuncile or other government organizations within the State of Colorado.
Colorado, counties, clues, towns, municipal corpora one, r a
Name of Government Gay
Rosily %Exempt
FProm Taxation
STATE BOARD OF LAND CONMTSSIONERS
12.50%
E. PURCHASER'S STATEMENT - List names and addresses of purchasers of oil and gas products. Attach separate sheet if necessary.
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. Information. end belief, sets forth a full and complete list of all taxable personal property owned by me or In my posaeseion. or under my control, located In this county 'n
Colorado on the assessment dale of this val: that such properly has been reasonably ducr Its value fairly represented; and attempt has been made to mislead the
assessor as to Its age, quality, quantity or value.' 39-5-107(2)C GIrGY='
DATE PONE 303-771-5511
ir
SIGNATURE PERSON
SR GNIAGENT Richard U. Logan, lax Rep. NAME OF OWNER Gerrity Oil & Gas Corporation
PRINT NAME OF PERSON SIGNING
PLEASE COMPLETE, SIGN, AND RETURN TO THE ASSESSOR ON OR BEFORE APRIL 15 (INSTRUCTIONS ON OTHER SIDE)
RETURN THIS COPY
520.2
15 OPT - AS Form 05-656 61 94
MAIL To WELD COUNTY ASSESSOR
1400 N. 171hAve. Greeley, CO 80631
Phone: (303) 353 -
State of Colorado
OIL AND GAS
REAL AND PERSONAL PROPERTY
DECLARATION SCHEDULE
19 94
Assessment Date Due Date
January 1 April 15
3&15 CONFIDENTIAL DATA
(One Well per Schedule)
YOU MUST FILE EVERY YEAR REGARDLESS IF ANY ADDITIONS OR DELETIONS WERE MADE
J 11 U 10S oAFlCEINUueensaEO L 21 316006001 04 OIL PIN NBA 0064892 PERSPINNBR 001 8247-70 2
B.A. CURE a s TA. CODE -
A. NAME AND ADDRESS (INDICATE ANY CHANGES)
CHANGE OF NAME AND/OR ADDRESS
GERRITY OIL i GAS CORPORATION
% LOGAN i FIRMINE INC
P 0 BOX 4274
ENGLEWOOD, CO 80155
NAME AND ADDRESS OF PREVIOUS OWNER(S)
B. STATUS OF PROPERTY PROPERTY LOCATION OR LEGAL DESCRIPTION:
11445-U LEASEHOLD INT NW4 16 3 65
LEASE NAME OR DESCRIPTION: 3
a G^ sr06/e,
first Return?
406
LLAN�D] me R
FIELD NAME: M �
COMPLETED:
is this your —YES —NO
APIs COGCC 0: DATE WLT.
_New Well_New Owner(s)0512315115
C. EQUIPMENT INVENTORY LISTING
NG wl�B# kkikx
Cl. WELL CHARACTERISTICS • A I rR
BASIN NAME II FMUF Re Jill FSniacin (n—JI DEPTH 7758 CLASS(check one): _OIL _X.GAS _ COAL SEAM GAS
C2. METHOD OF PRODUCTION - Check where applicable. AXMIXD IOXO( XIX *IXX%X X
SECONDARY WELL TYPE: _SUPPLY _DISPOSAL _ CO2 INJECTION _WATER INJECTION TANKS INSTALLED:x ON SITE _ COMMON TANK BATTERY
METHOD OF UFO. x FLOWING —PUMPING _ PLUNGER LIFT MOTOR TYPE:_ GAS — ELECTRIC _ESP lasts serswea soup)
C3. INSTALLED EQUIPMENT- Indicate the number of each on location. OVERALL EQUIPMENT CONDITION(CHECK ONE): _VERY GOOD AVERAGE MINIMUM
COUNT OF: _I —e TANKS _a TANKS IN COMMON TANK BATTERY *PRODUCTION UNITS) (SEPARATOR(S) —CHEATER TREATER(S)—IDEHYDRATOR(S)
Based on year of manulaclure, check the average age of installed welisite equipment. Years
Has any installed well Wir O_ YES
If yes lease describe Oequipment
M eoucmend tulioverhaul :
the lime oveMaul and the &WileIntr uthree yearst___ l
l years of Dcavell life added to
DESCRIPTION OF EQUIPMENT
the epuilnrenl. Attach separate sheet it necessary
DESCRIPTION OF MAJOR OVERHAUL
YEARS ADDED
C4. AMOUNTS OF PRODUCTION
OIL •3 BBL GAS irk; MCF WATER BBL DAYS CAPABLE OF PRODUCTION 36S STRIPPER WELL? .Yes_No
C5. ADDITIONAL INSTALLED EQUIPMENT • Indicate the number of each on location. (Attach additional tented listing if needed)
MeW EQUIPMENT DESCRIPTION led Units. ChesACers, Recycle AGo Pumps. end GBoretw Uns CameewyreHP) ndoes sum ma owl Radio TOOMOry Units, Cathodic Protection unity with Reales? or Solw P • Gm•Chemical Pumps,
Mine Heflin
DUANmY
CONDITION
--MIN _AVG _VGD
_MIN _ AVG __VGD
—MIN _ AVG ,VOD
GB. S I UH CU CUUIYMCPM I - IAaach motional itemize° rwerq n newest
EQUIPMENT DESCRIPTION
CONDITION
MAKE
MODEL
SIZE OR FOOTAGE
YEAR MFG.
—PAIN ,AVG NOD
JAIN _AVG _VGD
_MIN _ AVG NOD
- GAINED OR RENTED PROPERTYtD.Car•pwanyoAneabyoheso saactseparwsheet.
Id.LEASED,L
NAME AND ADDRESS OF OWNERILESSOR
DESCRIPTION
MODEL/SERIAL NO.
TERM (From -To)
ANNUAL RENT
THIS RETURN IS SUBJECT TO AUDIT
'I dorinrn under pnnnlly el portray In Ihn coonrd dnomn, hint Akin nchnduln, ?norther with any accompanying exhibits or statements. has been examined by me and to the best of my
knowledge, InInrInotlon. and belief. sets Inn lit n full mid cnnrpielo 1151 nl all taxable personal property owned by me or In my possession, or under my control, located In this county In
Colorado or, the assossmnnl dale of this year: that such property has d)n reasonably eacrl and its value fairly represented; and al o attempt has been made to mislead the
assessor as lo its age, quality, quantity or value.' 39.5-107(2)CRS
reasonably
S !,
SIGNATURE OF OWNER OR AGENT DATE
PRINT NAME OF PERSON SIGNING - NAME OF OWNER
PLEASE COMPI Fit, SIGN, AND RFI UI1N TO TI1E ASSESSOR ON OR BEFORE APRIL 15 (INSTRUCTIONS ON OTHER SIDE)
RE I URN 11112 COPY
ry PHONE
5233
PALiE 1 or 2
1B'DPT-AS Fan, DS -65581 94.
State of Colorado
OIL AND GAS
MAILTo WELD COUNTY ASSESSOR REAL AND PERSONAL PROPERTY
1400 N. 171h Ave, Greeley, CO 00631 DECLARATION SCHEDULE
Phone: (303) 3533&45 CONFIDENTIAL DATA
(One Well per Schedule)
YOU MUST FILE EVERY YEAR REGARDLESS IF ANY ADDITIONS OR DELETIONS WERE MADE
BA CODE 51311 TA CODE 0185 PARCEL NUMBER E. SEC) 121316000001 04 OIL PIN NBR 0064892 pERS PIHNBR 0018247-73-
19 94
Assessment Date
January 1
Due Date
April 15
A. NAME AND ADDRESS (INDICATE ANY CHANGES)
GERRITY OIL i GAS CORPORATION
% LOGAN S FIRMINE INC
P 0 BOX 4274
ENGLEWOOD, CO 80155
CHANGE OF NAMEAND/OR ADDRESS
B. STATUS OF PROPERTY PROPERTY LOCATION OR LEGAL DESCRIPTION:
11445-D LEASEHOLD INT NW4 16 3 65
LEASE NAME OR DESCRIPTION: MEGAN H1�3 04 O$ i 06
FIELD NAME: WELL AND NUMBER:
APIS COGCC 5•. 16-5 DATE WELL COMPLETED
0512315116
NAME AND ADDRESS OF PREVIOUSOWNER(3)
tatlse your first Return? —YESXNO
—New Wee —Mrs Owner's)
C. PRODUCTION REPORT FOR THE PREVIOUS YEAR - Check valuation method used.
R Actual Wellhead Price —Unrelated Party Netback (Producer) —Comparable Price Used to Value PROCESSOR'S Leasehold
..____—.,_ ..1__ , .__. � .._.._ ne.nn,,r.em,c. , �� , k I4 DaIa.aA Do.n. Mathun4 /D.M,.eaADmr•aaenrl
C1. PRIMARY PRODUCTION —ATTACH REPORT OF TIK OWNERS
i %IPS
FOR ASSESSORS USE ONLY
UNIT
TOTAL PRODUCED:
(SHOULDCRE FILE
FLARED, VENTED,
OR USED SE THE
A SOLD OR
FOM TRANSPORTEDLEASE
B. TOTAL VALUE
FOR
THE WELL SITE'
ALLOWED
LALTY USION -
EXCLEIVED
VALUAL
BBL
1,593.36
26,569.15
MCF
20,470.43
38,606.14
S� gg qq���Iodeadd prpyy Spx ��16��. 6aa,,7.�j BaBaLL
Box •B• Olrfdad by Sox A'. J—: A 4 t &, TOTALS
'Tote) Valle may to corrlpered to COGCC form 5 reported totals. Gas Volume reported Si 14.73 PSI - Industry standard, canted MDnr-C If pressure is different.
CL SECONDARY PRODUCTION —ATTACH REPORT OF TIK OWNERS i %'S
FOR ASSESSOR'S USE ONLY
UNIT
TOTAL PRODUCED
(SHOULD RECONCILE
TO COGCC FORM)
FLARED, VENTED.
OR USED ON THE
LEASE
A SOW OR
TRANSPORTED
FROM LEASE
S. TOTAL VALUE
RECEIVED FOR
THE `FELL SITE'
ALLOWED
FOYALTY
EXCLUSION
ACTUAL
VAI UE
BBL
MCF
tox•11• bgt •'.
TOTALS
Sommer. A/CF
'Teal Value may be compared to COGCC Ions S reported totals. Gas Vokx a reported at 14.73 PSI - Musty standard. contact COGCC Y pressure is afferent.
D. 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 govemment organizations within the State of Colorado.
Name of Government Entity
RovelN % Exempt
FFrom Taxation
State Board of Land Commissioners
12.502
E. PURCHASER'S STATEMENT - List names and addresses of purchasers of oil and gas products. Attach separate sheet if necessary -
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, information, and belief, sets forth a lull and complete Ilst of all taxable personal property owned by me or In my possession, or under my control, located in this county in
Colorado on the ment date of this year: that such property has been reasonably Q'scribed and its value fairly represented; and that no attempt has been made to mislead the
asesspr as to its age, quality, quantity or value.' 39-5-107(2 S /J�` 5% 57,4‘-
SIGNATURE OF OWNER OR AGENT •Cl// DATE PHONE 303-771-5511
PRINT NAME OF PERSON SIGNING Richard D- Logan. Tax Rep. NAME OF OWNER Gerrity Oil & Gas Corporation
PLEASE COMPLETE, SIGN, AND RETURN TO THE ASSESSOR ON OR BEFORE APRIL 15 (INSTRUCTIONS ON OTHER SIDE)
RETURN THIS COPY
YHUC L UI
C. EQUIPMENT INVENTORY LISTING
Cl. WELL CHARACTERISTICS-At1BAIVIARctfan
BASNNAME DENUER-JULESBLIRG (Dail oEPrs 7388 CLASS(th ck ale): _olL GAS _COAL SEAM GAS
C2 METHOD OF PRODUCTION - Check where applicable. AM1016(DOK 0(10K QkMU%X X
SECONDARY WELL TYPE: _SUPPLY —DISPOSAL — CO2 INJECTION _WATER INJECTION TANKS INSTALLED -LC ON SITE _ COMMON TANK BATTERY
METHOD OF LIFT: c FLOWING _PUMPING _ PLUNGER UFT MOTOR TYPE_ GAS — ELECTRICClaaesnap _ESP arrl. peel
RI
C3. INSTALLED EQUIPMENT- Indicate the renter of each on location. OVERALL EQUIPMENT CONDON(CHECK ONE): _VERY GOOD —11VERAGE _t≥_ MINIMUM
COUNT OF: a TANKS _I TANKS IN COMMON TANK BATTERY _CPRODUCTION UNIT(S) -eSEPARATOR(S) -CHEATER TREATER(S)-IDERYDRATOR(S)
BUM on you of manufacture, died: the avenge ego of Staled weew equipment.
7_ NO_ YES
I
yeast_
DESCRIPTION OF EQUIPMENT
520♦
15 OPT . AS Form DS -658 81 94
MAIL To WELD COUNTY ASSESSOR
t .1t3D)A Greeley, CO 80331
Phonic
YOU MUST
3
State of Colorado
OIL AND GAS
REAL AND PERSONAL PROPERTY
DECLARATION SCHEDULE
CONF1DEWTIAL DATA
(One Well per Schedule)
ALE EVERY YEAR REGARDLESS IF ANY ADDITIONS OR DELETIONS WERE MADE
0185 PARCEL NUMBERSSEC 121316000001 04 OIL PIN NOR 0064892 PERSPINNBR 00182`7-70.
19 Assessment Date 4 Due Date
January 1 April 15
A. NAME AND ADDRESS (INDICATE ANY CHANGES)
CHANGE OF NAME ANO/ORADDRESS
GERRITY OIL C GAS CORPORATION
% LOGAN G FIRMINE INC
P 0 801 4274
ENGLEWOOD; CO 80155
B. STATUS OF PROPERTY PROPERTY LOCATION OR LEGAL DESCRIPTION:
NAME AND ADDRESS OF PREVIOUS OWNERS)
11445—D LEASEHOLD INT N144 16 3 65
LEASE NAME OR DESCRIPTION: MEGA 1 6-03 4 05 C 06
FIELD NAME EANDNUM �6 ,-
Is this your first Rem? YES _NO
APE COGCC► DATE WELLCOM D:
0 52 2315116
—Nevi Wel _New Owner(*)
Years
Has any Staled well ate equipment undergone a maker ewlwl N 8r test three
w. Ewe cheat' the moment, Vie Noe of w . and the S VaW yeah of modVW+e lei added to the awkmlmnt Attach e5Mn$ anal I necessary
DESCRIPTION OF MAJOR OVERHAUL
YEARS ADDED
C4. AMOUNTS OF PRODUCTION
OIL .4,793 BBL GAS Dfl47O MCF WATER BBL DAYS CAPABLE OF PRODUCTION 2. STRIPPER WELL? �LYes_No
Remixed Ifaalg I
%no........,...in... ..... •---.....—. ____ _'_--_'___. _.
EQUIPMENT DESCRIPTION (Ieate wlea aid arY Rode laalnaey la Cahn* PmbNm Mt MIA Nam a 8car Pra Oa Meer Run. haw Ns
Lau W a OWNS Puna. Recxa Puna rid Gas Omar Ira Co pex lede ))
GUMMY
COMMON
—MIN — AVG VGD
_IAN _ AVG _VGD
—MN — AVG VDD
VV. V. Jni. �.. v.r...—... -Ww. r,•w.w.—..--- '. ._�
EQUIPMENT DESCRIPTION
CONDITION
MAKE
MODEL
SIZE OR FOOTAGE
YEAR MFG.
JAN _AVG VGD
VIN — AVG _VOG
—MN — AVG VOO
PITY (Deden wooerb owned Dy oden or attach Separate wet.)
NAME ANDADORESe OF OWNERILESSOR
DESCRIPTION
MODEUSERAL NO.
TERM (Froin-To)
ANNUAL RENT
DECLARATION
THIS RETURN IS SUBJECT TO AUDIT
'I declare under penalty of perlury 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, Information, and belief, sets forth a lull and complete let of all taxable personal property owned by me or In my possession. or under my control, located in this county in
Colorado on the Usesquality,
date this year; that such property has stub red Its value fairly represented; nthat attempt has been made to mislead the
assessor as to Its age 0uallty, quantity or value.' 39•S•107(2)CRS
SIGNATURE OF OWNER OR AGENT
PRINT NAME OF PERSON SIGNING
PLEASE COMPLETE, SIGN, AND RETURN TO THE ASSESSOR ON OR BEFORE APRIL 15 (INSTRUCTIONS ON OTHER SIDE)
RETURN THIS COPY
DATE
PHONE
NAME OF OWNER
t'tMlit 1 Ot
5 2., a
TS CPT -ASFomt DS-esa et 91,
&MIL To WELD COUNTY ASSESSOR
1100 N. 174 Ave. Greeley, CO 90831
Plwnt (303) 7134 ua
YOU MUST
RA CODE 51311 TA CODE
State of Colorado
OIL AND GAS
REAL AND PERSONAL PROPERTY
DECLARATION SCHEDULE
CONFIDENTIAL DATA
(One Well per Schedule)
FILE EVERY YEAR REGARDLESS IF ANY ADDITIONS OR DELETIONS WERE MADE
0185 PARCEL NUMBER ASEO 1 2 1 31 600000 1 04 OIL PIN NBA 0064892 PERS PSI NBR 00 1 8247-74) 1
19 94
Assessment Date
January 1
Due Date
April 15
A. NAME AND ADDRESS (INDICATE ANY CHANGES)
GERRITY OIL G GAS CORPORATION
t LOGAN t FIRMINE INC
P 0 BOX 4274
ENGLEWOOD. CO 80155
CHANGE OF NAME AND/OR ADDRESS
B. STATUS OF PROPERTY PROPERTY LOCATION OR LEGAL DESCRIPTION:
11445-D LEASEHOLD INT NW4 16 3 65
LEASE NAME OR DESCRIPTION: MEGAN 1116-03 04 05 5 06
FIELD NAME 1AlE WELL NAME AND NUMBER; //4v_(/�v
PPM COGCC Oh DVI�LL COMPLETED:
0512315075
NAME AND ADDRESS OF PREVIOUS OWNER(S)
•
X
tayea your firstRReturn?n7 _YES NO
_New Wel _New Owner(q
• C. PRODUCTION REPORT FOR THE PREVIOUS YEAR - Check valuation method used.
-Actual Wellhead Price —Unrelated Party Netback (Producer) —Comparable Price Used to Value PROCESSORS Leasehold
—Comparable Price Used to Value PRODUCER'S Leasehold —Related Party N
es. madapyppooucnoN —ATTACH REPORT OF TIK OWNERS t VS
UNIT
TOTAL PRODUCED:
(SHOULD RECONCILE
TO rrtnrc Ram
UAO
FLARED. VENTED.
OR USED ON THE
LEASE
A.
SOLD OR
TRANSPORTED
FROM LEASE
B. TOTAL VALUE
RECEIVED FOR
THE WELL SITE'
BBL
1,945.04
33,636.32
59,149.18
MCF
32,274.48
Bar •B py Bps /e 29yf lopaNf ggggLL
Bat'B' �'4"`• oy Bat A'. SSt MCF
TOTALS
FOR ASSESSOR'S USE ONLY
ALLOWED
EXXCLALTY CLUSION
TUAL
CVALUE
Tani Value may be compared to rnnrr loon 8 reported totals. Gas Volume reported at 14.73 PSI - Industry standard, contact COOCC y pressure is dllerenL
et SECONDARYPrOCUcnON -ATTACH REPORT OF TIK OWNERS t %IS
FOR ASSESSOR'S USE ONLY
UNIT
TOTAL PRODUCED:
(SHOULD RECONCILE
TO COOCC FORM)
FLARED. VENTED,
OR USED ON THE
LEASE
A. SOLD OR
TRANSPORTED
FROM LEASE
B. TOTAL VALUE
RECEIVED FOR
THE WELL RITE'
ALLOWED
FOYALTY
EXCI USION
ACTUAL
VAI UE
BBL
MCF
TOTALS
MI: 4 84 sA..
iStM.
Toni VS. rosy be compered to COGCC torn 8 reported totals. Gas Volume reported at 11.73 PSI • industry standard. contact COGCC If pressure 4 different
D. 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 organizations within the State of Colorado.
Name al Government Envy
Royaly % Exempt
From T xadcn
State Board of Land Commissioners
12.50%
E. PURCHASERS STATEMENT - List names and addresses of purchasers of oil and gas products. Attach separate sheet if necessary.
DECLARATION
THIS RETURN IS SUBJECT TO AUDIT
'I dealers under penalty of perjury In the second degree, that this schedule, together with any accompanying exhibits or statements. has been examined by me end to the best of my
knowledge. Information, and belief, sets forth a full and complete list of all taxable personal property owned by me or In my possession, or under my control. located in this county in
Colorado on the assessment date of this year: that such property has been reasonably described and its value Islay represented; and that no attempt has been made to mislead the
assessor as to Its age, quality, quantity or value.' 39-5-107 RS ..
SIGNATURE OF OWNER OR AGENT DATE PHONE 303-771-5511
PRINT NAME OF PERSON SIGNING Richard D. Logan. Tax Rep. NAME OF OWNER Gerrity Oil & Gas Corporation
PLEASE COMPLETE, SIGN, AND RETURN TO THE ASSESSOR ON OR BEFORE APRIL 15 (INSTRUCTIONS ON OTHER SIDE)
RETURN THIS COPY
PAU= G Of G
62 6
?5 OPT -AS Form OS -058 81 94
MAIL lb WELD COUNTY ASSESSOR
1400 N. 17th Ave. Greeley, CO 80631
Phone: (303) 3634845
YOU MUST
BA CODE 51311 TA CODE
State of Colorado
OIL AND GAS
REAL AND PERSONAL PROPERTY
DECLARATION SCHEDULE
CONFIDENTIAL chDATA
(One Well per Sedule)
FILE EVERY YEAR REGARDLESS IF ANY ADDITIONS OR DELETIONS WERE MADE
0185 PARCEL NUMBER 8SEO 121316000001 04 OIL PIN NBR
0064892 PERSPIN NBA 0018247-704
A. NAME AND ADDRESS (INDICATE ANY CHANGES) HA
GERRITY OIL t GAS CORPORATION
CHANGE OF NAME AND/OR ADDRESS
% LOGAN C FIRMINE INC
P 0 BOX 4274
ENGLEWOOD, CO 80155
B. STATUS OF PROPERTY PROPERTY LOCATION OR LEGAL DESCRIPTION:
NAME AND ADDRESS OF PREVIOUS OWNER(S)
11445-0 LEASEHOLD INT NM4 16 3 65
LEASE NAME OR DESCRIPTION: ME GILL 16-03 04 OS G 06
MELD NAME NNAME AND NUMF7ER:
M this your firer _YES ES —NO
API* COGCC I: DATE WELL _ PCETED
0512315075
—New Wes —New Owner(*)
C. EQUIPMENT INVENTORY LISTING
C1. WELL CHARACTERISTICS -A)taltkai og Wilitjhoninx
BASIN MAME DENUER.JULESBURG ID -J1 DEPTN 7335
C2. METHOD OF PRODUCTION - Check where applicable. AfttIIN II6Xt(XX ClUtXrXX9('X X
SECONDARY WELL TYPE: _SUPPLY _DISPOSAL _ CO2 INJECTION —WATER INJECTION TANKS INSTALLED X ON SITE _ COMMON TANK BATTERY
MOTOR TYPE_ GAS _ ELECTRIC _ESP caste swat carol
C3. INSTALLED EQUIPMENT • kldate the number of with on location. OVERALL EQUIPMENT CONDRpN(CHECK ONE): _VERY 0000 AVERAGE _ MINIMUM
COUNT OF: 1 I TANKS I TANKS IN COMMON TANK BATTERY 1 *PROOUCTI0NN UNR(S) ISEPARATOR(S) *HEATER TREATER(S)
Bawd on yew or manufacture. Wreck the swags age of installed white equipment Years
CLASS(ndt one). OIL _% .GAS _ COAL SEAM GAS
METHOD OF LIFT. (FLOWING _PUMPING _ PLUNGER LIFT
19 94
Assessment Date Due Date
January 1 April 15
Nee any installed well sitepulpnent_unMryar • mefor nscesuov
overhaul n me last three Team_ NO_ YES
8 __ _ease *salt '- the ?are .•
_ anti the _-_..._. _ .ersltKese_- _.._.._the _-"-- Attach ____ _. ...
DESCRIPTION OF MAJOR OVERHAUL
DESCRIPTION OF EQUIPMENT
.DEHYDRATOR(S)
YEARS ADDED
C4. AMOUNTS OF PRODUCTION _
OIL J 45. BBL OAS 4J.i '14 MCF WATER BBL DAYS CAPABLE OF PRODUCTION .36a STRIPPER WELL? _Yea No
CS. ADDITIONAL INSTALLED EQUIPMENT -India*, the number of sash an location. (Anach adduaw Itemized Wing Y needed)
EQUIPMENT DESCRIPTION lerpo Redo Varney LASS. Pwwd4, Mew nscet Sole:Pena Gee Molet Raw, Naw Hester,
GUAJmTY
COMMON
wows and mei Cathode With a
Led Unas. Choreal Pins. 1.gde PAM*. and Gee Booster LOIN Gorman 1540 NP)
—MN — AVG _VGD
JAN — AVG _VOD
JAN —AVG —VGD
CO. STORED EQUIPMENT - (mach additional Itemized Usurp 6 needed)
EQUIPMENT DESCRIPTION
CONDITION
MAKE
MODEL
SIZE OR FOOTAGE
YEAR MFG.
'
--MIN —AVG _VGD
JON — AVG V00
JAN — AVG _VGD
D. LEASED, LOANED, OR RENTED PROPERTY (Declare property owned by&here or attach womb *hest.)
NAME AND ADDRESS OF OWNERILESSOR
DESCRIPTION
MODEL/SERIAL NO.
TERM (From -To)
ANNUAL RENT
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 etetemonle, has been examined by me and to the but of my
knowledge, information, and belief, sets forth a full and complete Int of all taxable personal property owned by me or In my posensIon, or under my control, located in this county in
Colorado on the afeesemint date of this year; that such property h en reasonably descrl and its value fairly represented; and th t n attempt has been made to mislead the
ueeeeor as to its age, quality, quantity or value.' 30-5-107(2)C
SIGNATURE OF OWNER OR AGENT DATE PHONE
PRINT NAME OF PERSON SIGNING NAME OF OWNER
PLEASE COMPLETE, SIGN, AND RETURN TO THE ASSESSOR ON OR BEFORE APRIL 15 (INSTRUCTIONS ON OTHER SIDE)
RETURN THIS COPY
Hello