ANNUAL RETURN TO NEW SHOREHAM, RI ASSESSOR

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ANNUAL RETURN TO NEW SHOREHAM, RI ASSESSOR Rhode Island law requires the annual filing of a true and exact account, MADE UNDER OATH, of all ratable estate owned or possessed by every person and body corporate. The time to file is from DECEMBER 31 through JANUARY 31, inclusive, each year. If for any reason you are unable to file your account by January 31, you may, prior to midnight of January 31, submit a written notice of your intention to file your account between March 1 and March 15. Such notice of intention should be sent by prepaid registered or certified mail, and must be postmarked before midnight of January 31. NO EXTENSIONS BEYOND MARCH 15 CAN BE GRANTED. To assist you in the complying with the law, you will find enclosed the Annual Return to RI Assessor form. Please take the time to read the instructions which follow. As this is a standardized form, please complete in full those sections which pertain to you and indicate N/A (not applicable) in those sections which do not apply to you. Instructions for Completing Page 1 (cover) of return: Check the printed mailing label (if one is provided on the back cover) and make any necessary corrections to insure that the name of the assessed person(s) and the mailing address are accurate. Check the appropriate box and complete in full the ownership classification Complete the owner s name, business name, business address and mailing address section. Complete the name, title, and the residential address of the individual who signs this return as well as a brief description of the business and number of employees. Section 1- Computer Equipment Please list computer equipment used in the day to day operations of your business. Peripherals (monitors, printers, etc.) should be listed section 3 List equipment by year, make and model, using a separate sheet if necessary. Manufacturers should include all computer equipment not used directly in the ACTUAL manufacturing process. IMPORTANT~ be sure to declare all acquisitions still in use, even if fully depreciated on your books. List all LEASED assets in Section 8 Section 2-Tangible Personal Property Any and all of the following that are used in conducting the operations of any Retail, Wholesale, Service, Contracting, Professional of any other type of business are to be reported in this section: o Furniture o Fixtures o Equipment o Tools o Signs o Unregistered Motor Vehicles. Manufacturers should include all equipment not used directly in the ACTUAL manufacturing process. IMPORTANT~ be sure to declare all acquisitions still in use, even if fully depreciated on your books. List all LEASED assets in Section 8. All Computer equipment should be listed in Section 2.

Section 3- Long Life s o Please list by year the total acquisition cost for assets that have an economic life of 13 years or more. o Manufacturers should include all equipment not used directly in the ACTUAL manufacturing process. o IMPORTANT~be sure to declare all acquisitions still in use, even if fully depreciated on your books. o List all LEASED assets in Section 8 o Do not duplicate assets listed in section 2 or 3. Section 4-Disposed s o Include any asset that has been previously reported that is no longer in your possession. o s may include those that may have been reported in either sections 2, 3, or 4 in prior years. o Any asset that has not been disposed will remain on your asset list. Section 5-Leased, Rented, Consigned Tangible Personal Property. o This section is to be used by all businesses including manufacturers. o This refers to property which YOU lease or rent from others, excluding registered motor vehicles. o This does not include retail space Section 6- Tangible Personal Property Leased or Rented to Others o Declare any tangible personal property, excluding registered motor vehicles, which you leased or rented to others. o Include a separate schedule that details: Location of property of property YOUR acquisition cost Date of acquisition or installation Date of manufacture Monthly rental or lease income Dates of lease. Section 7-Leasehold Improvements o List fixtures or improvements owned by you but attached to or used in real estate owned by another and that are not reported elsewhere. Such improvements may include wall paneling, carpeting, tile on walls and floors, electrical and plumbing fixtures. Section 8-Signing Your Return. o If not signing in person, you will need to have your return notarized by an authorized agent. Section 9-True and Exact Account of all Ratable Real Estate Owned Complete Section 10 by listing each parcel of real estate owned as of the assessment date of December 31, providing the full claimed value. o Provide the physical address of the property as well as a brief description o Include the Plat and Lot of the specific parcel o Give an opinion of value for the Improvements (buildings) and the Land.

Annual Return to New Shoreham, R.I. Tax Assessor The Law is Mandatory A Return Must Be Filed (RI Law Section 44-5-15, as amended) And Mail To: Tax Assessor, PO BOX 220, Block Island RI 02807 Statement of Valuation as of 12/31/2017 Date Received: For your convenience, we have supplied you with this form for the declaration of taxable property located in Rhode Island. According to the General Laws of Rhode Island, taxable property must be declared to the Assessor between December 31, 2017 and January 31, 2018. If a taxpayer is unable to make such declaration within the prescribed time, they may submit written notice by certified mail, prior to January 31, of intention to submit declaration by March 15. Failure to file a true and full account, within the prescribed time, eliminates the right to appeal. No amended returns will be accepted after March 15 th. Thank you for your cooperation. If we can be of assistance in preparing your report, feel free to come to our office at Town Hall, 16 Old Town Road, Block Island RI, or call (401) 466-3217. STATE LAW REQUIRES THE FILING OF THIS DECLARATION. FAILURE TO DO SO MAY RESULT IN AN INCREASED ASSESSMENT. Ownership: Corporation/LLC Co-Partnership Individual/Sole Proprietorship ACCOUNT NUMBER: Owners Name(s): Business Name / DBA: Business Address: Mailing Address: (if different from above) I, My Residence Is: (Name) (Title) am responsible for the information contained within this form. My Daytime Phone Number Is: Give a of Your Business Operation: Mfg. Wholesale Retail Service Other Number of Employees as of December 31, 2017 IF YOU NO LONGER MAINTAIN A BUSINESS WITH IN THE TOWN LIMITS, PLEASE CONTACT OUR OFFICE MONDAY THROUGH FRIDAY, 9:00-3:00 TO BE REMOVED FROM THE ACTIVE TAX ROLLS. FAILURE TO CLOSE YOUR BUSINESS WILL RESULT IN THE ACCRUAL OF ANNUAL TAXES.

SECTION 1 COMPUTER EQUIPMENT ONLY Please list computer equipment separately in this section by year, make, and model with description of each piece owned. Manufacturers include all computer equipment NOT used directly in the actual manufacturing process. Attach a separate sheet if necessary. List all leased / rented equipment in Section 8. 2017 Laptop $1,000.00 5% $950.00 Calendar Year SECTION 2 TANGIBLE PERSONAL PROPERTY List by year the total acquisition cost for all furniture, fixtures, equipment, signs and unregistered vehicles owned by you that are used in conducting the operations of any retail, wholesale, service, contracting, professional or other type of business. Manufacturers should only report furniture, fixtures and equipment that are NOT used directly in the actual manufacturing process. IMPORTANT ~ be sure to declare all acquisitions still in use, even though fully depreciated on your books. List all leased / rented equipment in Section 8. Be sure to list all computer equipment separately in Section 2. 2017 Furniture $500.00 50% $250.00 Calendar Year Acquisition Acquisition Depreciation Rate 2017 5% 2016 20% 2015 40% 2014 60% 2013 & Prior 80% TOTAL Depreciation Rate 2017 5% 2016 10% 2015 20% 2014 30% 2013 40% 2012 50% 2011 60% 2010 & prior 70% TOTAL SECTION 3 LONG LIFE ASSETS Claimed Full Value Claimed Full Value Use Only Use Only Please list by year the total acquisition cost for assets that have an economic life of 13 years or more. Manufacturers should only report assets that are NOT used directly in the actual manufacturing process. IMPORTANT ~ be sure to declare all acquisitions still in use, even though fully depreciated on your books. List all leased equipment in section 8. DO NOT DUPLICATE ASSETS REPORTED IN SECTIONS 2 & 3. 2017 Fiber Cable $8,000.00 20% $6,400.00 Calendar Year Acquisition Depreciation Rate 2017 5% 2016 10% 2015 15% 2014 20% 2013 25% 2012 30% 2011 35% 2010 40% 2009 45% 2008 50% 2007 55% 2006 60% 2005 65% 2004 & Prior 70% TOTAL Claimed Full Value Use Only

SECTION 4 DISPOSED ASSETS Please list any assets which were disposed within the reporting year. Please provide original acquisition year, a brief description of asset and original acquisition cost. Any asset that had been previously reported and has not been disposed will remain on your asset list. 2017 Laptop Computer 900.00 Calendar Year Original Acquisition SECTION 5 LEASED / RENTED / CONSIGNED This Section to be used by All Businesses TANGIBLE PERSONAL PROPERTY INCLUDING MANUFACTURERS These are assets that YOU lease from another company Owner / Address Item New Lease Term Monthly Rent Lease # SECTION 6 TANGIBLE PROPERTY LEASED OR RENTED TO OTHERS On December 31, 2017, if you owned any items of tangible personal property (except registered motor vehicles), which you leased or rented to others, attach a separate schedule to this form and report all of the following information for each item: Lessee s name and location of property, description of property, your acquisition cost, date of acquisition or installation, date of manufacture, monthly rental or lease income, and dates of lease. SECTION 7 LEASEHOLD IMPROVEMENTS Fixtures, etc. owned by you and attached to or used in real estate owned by others and not reported elsewhere. Leasehold improvements include, but are not limited to, wall paneling, carpeting, tile on wall and floors, ceilings, electrical and plumbing fixtures, partitions, cabinetry, lighting, building additions and the like. Track 2017 lighting & $1,300.00 10% 1,170.00 Countertops Calendar Year Acquisition Depreciation Rate 2017 5% 2016 10% 2015 20% 2014 30% 2013 40% 2012 50% 2011 60% 70% 2010 & Prior TOTAL Claimed Full Value Use Only

SECTION 8 SIGN YOUR RETURN AND NOTARIZE I do hereby certify and declare that, to the best of my knowledge and belief, the foregoing is a true and complete list of all real estate and personal property owned by said Corporation, Co-Partnership or Individual, in or ratable in said Town on the said thirty-first day of December, 2017 at 12 o clock midnight, Eastern Standard time; that the value placed against each item thereof is the full and fair-cash value thereof at said time. Please Sign Here Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. Signature Date Title On, personally appeared before me and made oath that the foregoing account, by him/her signed and exhibited, contains to the best of his/her knowledge and belief, a true and full account and valuation of all the ratable estate owned or possessed by said corporation, co-partnership, or individual. Signature of Notary Public and Date My Commission Expires: IMPORTANT INFORMATION *IF YOU NO LONGER MAINTAIN A BUSINESS WITH IN THE TOWN LIMITS, PLEASE CONTACT OUR OFFICE MONDAY THROUGH FRIDAY, 9:00-3:00 TO BE REMOVED FROM THE ACTIVE TAX ROLLS. FAILURE TO CLOSE YOUR BUSINESS WILL RESULT IN THE ACCRUAL OF ANNUAL TAXES. *LEASING COMPANIES SHOULD ALSO PROVIDE A DISPOSITION LIST. PLEASE INCLUDE THE DATE THAT THE LEASE WAS TERMINATED, AND WHAT WAS THE ACTION TAKEN (Was the property returned to you, sold to the lessee, etc.)

SECTION 9 REAL ESTATE Complete Section 10 by listing each parcel of real estate owned as of the assessment date of December 31, providing the full claimed value. o Provide the physical address of the property o Include the Plat and Lot of the specific parcel o Give an opinion of value for the Improvements (buildings) and the Land If You Need Additional Space Attach Addendum I, do hereby certify that the following is a true and complete list of all ratable real estate owned in said Town of New Shoreham on the thirty-first day of December, 2017. 43 Broadway Office Building P-21 L-136 10,212,000 1,468,000.00 LOCATION & DESCRIPTION Plat Lot Improvements Claimed Full Value Land

Tax Office Town Hall P O Drawer 220 Block Island RI 02807 THIS NAME AND ADDRESS WILL BE USED FOR TAX BILLS. PLEASE CHANGE IF INCORRECT