TANGIBLE PERSONAL PROPERTY LISTING eFORMFor each page, use the TAB key to move to the next fill-in space and enter information.*Required InformationFor Washington State County ofWHATCOMAs of January 1, 2011Personal PropertyAccount/Parcel # (if known)UBI #SIC or NAICS CodeMonth/Year business or farm began operating in this county:MonthYearYes*Business/Taxpayer Name: In Bankrupcy?*Phone Number:Fax #:E-mail:*Mailing Address:*City:*State:Zip Code:*Name of Person Submitting Report:*Check the boxes to verify if: 1) The person submitting the report is authorized to do so. 2) The person submitting verifies that the information is true & correct.Person to Contact Concerning This Report:*Name:Title:Address:City:State:*Phone:*E-Mail:NoYesYesZip Code:Fax #:*Location/Address of property:*City:*Describe type of business:Real Property Parcel #:If business is farming, describe type above and complete an \"Application for Exemption of Farm Machinery & Equipment\" form at:http://dor.wa.gov/docs/forms/PropTx/forms/AppForExmptMachEquip.docHead of Family Exemption QualificationIs the owner/user of the property a Sole Proprietor or the only beneficiary of a Trust?. . . . . . . . . .If \"YES\" please answer the questions below.Does the owner/user of the property reside with other family members?. . . . . . . . . . . . . . . . . . . . .Does the owner/user of the property receive an old age pension under the laws of WA State?. . . . Is the owner/user of the property a surviving spouse who has not remarried (widow or widower)? Check the applicable boxes below.YesNoYesYesYesYesNoNoNoNoIs the owner/user of the property a US Citizen, over age 65, who has lived in the state for at least 10 yrs?Owner/user may receive only one Head of Family Exemption (HOF) on Personal Propertyparcel/account in Washington State. If you qualify for the HOF exemption do you want this to bethe account where the exemption is applied? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesNoPlease list below all real and personal property account numbers for the taxpayer reporting personal property located in the county.REV 64 0102e (2/1/11)
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