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• MUST BE FILED WITH II. ASSESSOR ON OR II Nebraska Personal Property Return Tax Year 2013 1 I3- MAY 1, 0 �i Net Book Value PENAL ASSESSED •Attach all supporting schedules County HALL • • Property Address p different) i' City State Zip Code Telephone Number Tax District • la 'i 801-566-9201 5 • Legal Description Property Type Schedule Number' Commercial 400498396 PACIFIC WESTERN EQUIPMENT FINANCE RETURN To: %ST FRANCIS MED CENTER HALL O NTYLASE HL COUNTY ASSESSOR 6975 UNION PARK CENTER STE 200 121 S PINE, SUITE 1 MIDVALE UT 84047- GRAND ISLAND NE 68801- Totals Taxable Value 1 Commercial and industrial total (from schedule) 1 495,648 2 Agricultural machinery and equipment total (from schedule) 2 0 3 1027 Exemption 3 4 TOTAL TAXABLE VALUE (total of lines 1 and 2) 4 495,648 Describe any leased or consigned property in your custody,and list name and address of lessor: Description of Property Name and Address of Lessor or Owner Under penalties of law,I declare that I have examined this return,and to the best S my knowledge and belief,it is correct and complete. FILED ON BEHALF Sin ' . . 4 a 9 P ` ER Date Here _ I s. -zi dalf,c2(7241d Signature of Prepare(Other th. gr COUNTY ASSESSOR'S USE ONLY Depreciation Worksheet Reviewed +. PENALTY ill ilk ❑ 25% Date Initials Signature city Assessor - Date • INS TRUCTIONS • WHO MUST FILE. If you hold or own any taxable tangible personal property on January.1 at 12:01 a.m.of the year for which the assessment is being made,you must file a Nebraska Personal Property Return. ' If you lease property from another person,you must file a Nebraska Personal Property Return. If you lease property to another person,you must file a Nebraska Personal Property Return. If you bring property into the state between January 1 at 12:01 a.m.and July 1,you must list the property on or before July 31,unless you can show the property was purchased after January 1 at 12:01 a.m.or was assessed in another county or state. WHEN AND WHERE TO FILE This retum must be filed on or before May 1 with the assessor for the county in which the property is located. If you have property in more than one county, you must file a retum with each county in which you have property. If you have property at more than one location in the same county,contact the assessor to determine if more than one return is required. SITUS FOR PROPERTY Property of an established agricultural or commercial business is assessed at the place of business unless the property has acquired local situs elsewhere. Property will acquire local situs elsewhere if it is kept in a location,other than the location of the business,for the greater portion of the calendar year.