California 571 PreparerTM 30% DISCOUNT FIRST-TIMEUSERSONLY FREESHIPPING ATSHOW ONLY Tax
CFS Tax Software Inc 1445 Los Angeles Ave Ste 214 Simi Valley CA 93065 Tel: (800) 343-1157 Fax: (805) 522-0187 May 1, 2013 Acme Business Services 3100 Main Street, Ste. 125 Simi Valley CA 93065-2222 RE: A.P.N. 14343-46577-456456 Dear Jim, Enclosed is your Business Property Statement Form 571-L. payment is due with this return. The return should be attached to the original Form 571-L sent to you by your county assessor. The return should be mailed on or before April 1, 2013. The return will be considered delinquent and subject to a 10% penalty if not mailed by May 7, 2013. Mail your return to: Assessor, Dan Goodwin, Ventura County 800 South Victoria Ave. Ventura, CA 93009-1270 Before mailing, be sure to review the return and sign where designated. You should receive a bill for your unsecured business property taxes no later than July 31, 2013. Your unsecured business property taxes are due no later than September 1, 2013. Sincerely, Pete Wilson
CFS Tax Software Inc 1445 Los Angeles Ave Ste 214 Simi Valley CA 93065 Tel: (800) 343-1157 Fax: (805) 522-0187 May 1, 2013 Acme Business Services 3100 Main Street Simi Valley CA 93065-2222 For Professional Services Rendered: Total Fee... $75.00
BOE-571-L (P1) REV. 18 (05-12) Assessor, Dan Goodwin, Ventura County 571-L 2013 800 South Victoria Ave., Ventura, CA 93009-1270 (805) 654-2181 BUSINESS PROPERTY STATEMENT FOR 2013 (DECLARATION OF S AND OTHER RELATED PROPERTY INFORMATION AS OF 12:01 A.M., JANUARY 1, 2013) RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED. FILE RETURN BY APRIL 1, 2013 NAME AND MAILING ADDRESS. (Make necessary corrections to the printed name and mailing address.) LOCATION OF THE BUSINESS PROPERTY PART I: GENERAL INFORMATION COMPLETE (a) THRU (g) a. Enter type of business: b. Enter local telephone number: (805) 423-7894 FA number (805) 423-7888 E-Mail Address (optional) james@acmebusiness.com c. Do you own the land at this business location? Yes If yes, is the name on your deed recorded as shown on this statement? Yes d. When did you start business at this location? DATE: 05/15/1994 If your business name or location has changed from last year, enter the former name and/or location: Acme Tax Services 3105b Main Street Simi Valley CA 93065 e. Enter location of general ledger and all related accounting records (include zip code): 1505 Cliff Shore Drive Costa Mesa CA 92626 PART II: DECLARATION OF PROPERTY BELONGING TO YOU (attach schedule for any adjustment to cost) 1. Supplies 2. Equipment (From line 35) 3. Equipment out on lease, rent, or conditional sale to others (Attach Schedule) 4. Bldgs., Bldg. Impr., and/or Leasehold Impr., Land Impr., Land (From line 71) 5. Construction In Progress (Attach Schedule) 6. Alternate Schedule A (See instructions) 7. 8. PART III: DECLARATION OF PROPERTY BELONGING TO OTHERS - IF NONE WRITE ''NONE'' (SPECIFY TYPE BY CODE NUMBER) Report conditional sales contracts that are not leases on Schedule A 4. Vending equipment 5. Other businesses 6. Government-owned property 1. Leased equipment 2. Lease-purchase option equipment 3. Capitalized leased equipment 9. Lessor's name Mailing address 10. Lessor's name Mailing address Tax Obligation: A. Lessor B. Lessee OWNERSHIP TYPE ( ) Proprietorship Partnership Corporation Other Retail BUSINESS ( ) DESCRIPTION Wholesale Manufacturer Service/Professional Acme Business Services 3100 Main Street, Ste. 125 Simi Valley CA 93065-2222 Accounting STREET CITY RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED. FILE A SEPARATE STATEMENT FOR EACH LOCATION. f. Enter name and telephone number of authorized person to contact at location of accounting records: Joe Taxman (805) 425-3456 g. During the period of January 1, 2012 through December 31, 2012: (1) Did any individual or legal entity (corporation, partnership, limited liability company, etc.) acquire a ''controlling interest'' (see instructions for definition) in this business entity? Yes (2) If YES, did this business entity also own ''real property'' (see instructions for definition) in California at the time of the acquisition? Yes (3) If YES to both questions (1) and (2), filer must submit form BOE-100-B, Statement of Change in Control and Ownership of Legal Entities, to the State Board of Equalization. See instructions for filing requirements. (omit cents) (see instructions) 253,108 12,900 439,400 10,000 Year of Acq. DECLARATION BY ASSESSEE 4205 West 52nd Avenue Simi Valley, CA 93065 14343-46577-456456 Year of Mfr. Description and Lease or Identification Number Cost to Purchase New te: The following declaration must be completed and signed. If you do not do so, it may result in penalties. I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, including accompanying schedules, statements or other attachments, and to the best of my knowledge and belief it is true, correct, and complete and includes all property required to be reported which is owned, claimed, possessed, controlled, or managed by the person named as the assessee in this statement at 12:01 a.m. on January 1, 2013. SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT* DATE 05/01/2013 NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed) James Smith TITLE Owner NAME OF LEGAL ENTITY (other than DBA)(typed or printed) FEDERAL EMPLOYER ID NUMBER Acme Business Services 33-4578879 PREPARER'S NAME AND ADDRESS (typed or printed) TELEPHONE NUMBER TITLE Pete Wilson (310) 111-3132 Accountant 3456 East 8th Street # Torrance, CA 90504 *Agent: See page 7 for Declaration by Assessee instructions. THIS STATEMENT SUBJECT TO AUDIT INFORMATION PROVIDED ON A PROPERTY STATEMENT MAY BE SHARED WITH THE STATE BOARD OF EQUALIZATION -1- Annual Rent TO BE USED AS AN ATTACHMENT TO THE ''SIGNED ORIGINAL 571-L'' AS PRINTED BY THE ASSESSOR, REVENUE AND TAATION CODE SECTION 441.5.
Acme Business Services, 14343-46577-456456 Equipment Out on Lease or Rent to Others Detail PAGE: 1A Name Address Location Quantity Equipment Total:
Acme Business Services, 14343-46577-456456 Equipment Out on Lease or Rent to Others Detail PAGE: 1B Description Acq. Date Cost Price Rent Equip. ID Lease Date Lease Dur. How Acquired 03/01/2012 12,900 Totals: 12,900
Acme Business Services, 14343-46577-456456 PAGE: 1 Description Amount Construction 10,000 Total: 10,000 Construction in Progress Detail
Acme Business Services, 14343-46577-456456 BOE-571-L (P2) REV. 18 (05-12) SCHEDULE A -- DETAIL: EQUIPMENT (Do not include property reported in Part III.) Include expensed equipment and fully depreciated items. Include sales or use tax (see instructions for important use tax information), freight and installation costs. Attach schedules as needed. Lines 18, 32, 33, and 45 ''Prior'' - Report detail by year(s) of acquisition on a separate schedule. L I N E N O Calendar Yr. of Acq. 1. MACHINERY AND EQUIPMENT FOR INDUSTRY, PROFESSION, OR TRADE (do not include licensed vehicles) 2. OFFICE FURNITURE AND EQUIPMENT 3. OTHER EQUIPMENT (describe) Calendar Yr. of Acq. 4. TOOLS, MOLDS, DIES, JIGS 11 2012 1, 2,700 2,800 2012 4, 12 2011 1, 2,700 2,800 2011 4, 13 2010 2,500 2,700 2,800 2010 4, 14 9 1, 2, 3, 9 4, 15 8 1,100 2, 3,300 8 4,400 16 7 7 17 6 2,500 3,500 6 4,500 18 5 1,002 2,002 3,002 Prior 4,002 19 20 21 22 4 3 2 1 30,000 Total Calendar Yr. of Acq. 5a. 33,702 PERSONAL COMPUTERS 23 0 300 2012 5,600 24 1999 300 2011 5,600 25 1998 300 2010 5,600 26 1997 300 9 6,500 27 1996 300 8 8,500 28 1995 300 7 6,000 29 1994 300 6 6,500 30 1993 5 520 31 1992 4 520 32 1991 Prior 0 33 34 35 Prior 12, Total 31,102 Add TOTALS on Lines 19, 33, 34, 46 and any additional schedules. ENTER HERE AND ON PART II, LINE 2 0 60,102 0 37,902 253,108 Total Calendar Yr. of Acq. 5b. LOCAL AREA NETWORK (LAN) EQUIPMENT AND MAINFRAMES 45,340 36 37 38 39 40 CLASSIFICATION Machinery & equipment Office furniture & equipment Tools, molds, dies & jigs COL. 1 2 4 FULL VALUE BASE FULL VALUE PERS. PROP. RCLND PERS. PROP. ADJUSTMENT PERS. PROP. FULL VALUE 2012 2011 2010 9 8 7,500 7,500 7,500 7,800 7,400 41 Personal Computers 5a 7 42 LAN and Mainframe 5b 6 2,500 43 44 45 Other equipment Schedule B - Fixtures 3-5 4 Prior 360 360 2,040 46 TOTALS -2- Total 44,960
Acme Business Services, 14343-46577-456456 PAGE: 1 Schedule A - Cost Detail : Equipment Detail Col. 1 Cost Col. 2 Cost Col. 3 Description Col. 3 Cost Col. 4 Cost Col. 5a Cost Col. 5b Cost Year Mach. & Equip. Off. Furn. & Equip. Other Equip. Other Equip. Tools, Molds Personal Computers LAN Equipment and Mainframes 2012 1, 2,700 2,800 4, 5,600 7,500 2011 1, 2,700 2,800 4, 5,600 7,500 2010 2,500 2,700 2,800 4, 5,600 7,500 9 1, 2, 3, 4, 6,500 7,800 8 1,100 2, 3,300 4,400 8,500 7,400 7 6,000 6 2,500 3,500 4,500 6,500 2,500 5 1,002 2,002 3,002 4,002 520 360 4 520 360 3 30,000 2,040 2 1 0 300 1999 300 1998 300 1997 300 1996 300 1995 300 1994 300 1993 1992 1991 1990 12, Totals: 31,102 60,102 37,902 33,702 45,340 44,960
Acme Business Services, 14343-46577-456456 BOE-571-L (P3) REV. 18 (05-12) SCHEDULE B - DETAIL: BUILDINGS, BUILDING IMPROVEMENTS, AND/OR LEASEHOLD IMPROVEMENTS, LAND IMPROVEMENTS, LAND AND LAND DEVELOPMENT Attach schedules as needed. Line 69 ''Prior'' -- Report detail by year(s) of acquisition on a separate schedule. L I N E N O Yr. of Acq. 1. BUILDINGS, BUILDING IMPROVEMENTS, AND/OR LEASEHOLD IMPROVEMENTS STRUCTURE ITEMS ONLY (see instructions) 2. FITURES ONLY (see instructions) 3. LAND IMPROVEMENTS (e.g., blacktop, curbs, fences) 4. LAND AND LAND DEVELOPMENT (e.g., fill, grading) 47 2012 7,450 48 2011 7,450 49 2010 7,450 50 9 7,450 51 8 7,450 7,450 7,450 52 7 53 6 5,250 5,250 5,250 5,250 54 5 55 4 56 3 57 2 58 1 59 0 60 1999 20,000 61 1998 62 1997 63 1996 64 1995 65 1994 66 1993 67 1992 68 1991 69 Prior 1 1 2 28,000 70 Total 76,750 110,750 114,950 136,950 71 Add TOTALS on line 70 and any additional schedules. ENTER HERE AND ON PART II, LINE 4 439,400 72 Have you received allowances for tenant improvements for the current reporting period that are not reported above? Yes If yes indicate amount $ REMARKS: sample remarks go here Calendar -3-
Acme Business Services, 14343-46577-456456 PAGE: 1 Schedule B - Buildings, Improvements Detail Col. 1 Cost Col. 2 Cost Col. 3 Cost Col. 4 Cost Year Structure Items Only Fixtures Only Land Improvements Land and Land Development 2012 7,450 2011 7,450 2010 7,450 9 7,450 8 7,450 7,450 7,450 7 6 5,250 5,250 5,250 5,250 5 4 3 2 1 0 1999 20,000 1998 1997 1996 1995 1994 1993 1992 1991 1990 1 1 2 28,000 Totals: 76,750 110,750 114,950 136,950
Acme Business Services, 14343-46577-456456 BOE-571-D (FRONT) REV. 14 (05-12) SUPPLEMENTAL SCHEDULE FOR REPORTING MONTHLY ACQUISITIONS AND DISPOSALS OF PROPERTY REPORTED ON SCHEDULE B OF THE BUSINESS PROPERTY STATEMENT Acme Business Services OWNER NAME 3100 Main Street, Ste. 125 Simi Valley CA 93065-2222 MAILING ADDRESS 4205 West 52nd Avenue Simi Valley, CA 93065 LOCATION OF PROPERTY INSTRUCTIONS Report all acquisitions and disposals reported in Columns 1, 2, 3, or 4 on Schedule B for the period January 1, 2012 through December 31, 2012. Indicate the applicable column number in the space provided. ADDITIONS - Describe and enter the total acquisition cost(s), including excise, sales, and use taxes, freight-in, and installation charges, by month of acquisition; transfers-in should also be included. The former property address and date of transfer should be reported, as well as original date and cost(s) of acquisition. Only completed projects should be reported here (e.g., the date the property becomes functional and/or operational, otherwise it should be reported as construction-in-progress). Identify completed construction that was reported as construction in progress on your 2012 property statement. Describe the item(s) and cost(s), as previously reported, on a separate schedule and attach to Form BOE-571-D. DISPOSALS- Information on this property should include the disposal date, methods of disposal (transfer, scrapped, abandoned, sold, etc.) and names and addresses of purchasers when items are either sold or transferred. ADDITIONS DISPOSALS FROM ENTER MONTH COLUMN & YEAR OF NUMBER AQUISITION DESCRIPTION FROM COLUMN NUMBER ENTER MONTH & YEAR OF DISPOSAL YEAR ACQRD DESCRIPTION 2 01/9 Equipment 7,000 1 01/2012 5 Machinery 2,500-4- THIS STATEMENT SUBJECT TO AUDIT
BOE-571-F (P1) REV. 16 (05-12) 571-F Assessor, Dan Goodwin, Ventura County 2013 AGRICULTURAL PROPERTY STATEMENT FOR 2013 (Declaration of costs and other related property information as of 12:01 A.M., January 1, 2013) RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED. FILE RETURN BY APRIL 1, 2013. NAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address) LOCATION OF THE PROPERTY (file a separate statement for each location) 3100 Main Street Suite 125 Simi Valley CA 93065 PART I: GENERAL INFORMATION [complete (a) through (i)] a. Enter type of farm or business: b. Enter local telephone no. Hog Farm (805) 423-7894 FA no. (805) 423-7888 E-Mail Address (optional) james@acmebusiness.com c. Do you own the land at this location? If yes, is the name on your deed recorded as shown on this statement? Yes Yes Tax Rate Area Assessor Only PART II: DECLARATION OF PROPERTY BELONGING TO YOU (attach schedule for any adjustment to cost) 1. Supplies (from Schedule A) 2. Animals 3. Fixed machinery and equipment 4. Movable farm equipment 5. Office furniture and equipment 6. Equipment out on lease, rent, or conditional sale to others 7. Construction in progress (CIP) (from Schedule B) (from Schedule C) (from Schedule D) (from Schedule E) (attach schedule) (attach schedule) d. When did you start business at this location? DATE: 06/15/1962 e. Enter location of general ledger and all related accounting records (include zip code): 4205 James St f. Enter name and telephone no. of authorized person to contact at location of accounting records: Jim Smith (714) 567-9788 g. During the period of January 1, 2012 through December 31, 2012: (1) Did any individual or legal entity (corporation, partnership, limited liability company, etc.) acquire a ''controlling interest'' (see instructions for definition) in this business entity? Yes (2) If YES, did this business entity also own ''real property'' (see instructions for definition) in California at the time of the acquisition? Yes h. Do you have: (1) Registered or show horses? Yes (2) Racehorses? Yes (If yes is checked, see instructions) i. Are there manufactured homes/mobilehomes located on the property? Yes If yes, indicate: (3) If YES to both questions (1) and (2), filer must submit form BOE-100-B, Statement of Change in Control and Ownership of Legal Entities, to the State Board of Equalization. See instructions for filing requirements.. currently licensed. not currently licensed 8. Other Other description 2,500 PART III: REAL PROPERTY ALTERATIONS Have you made any changes to the real property this past year? Yes If Yes, please complete Part III - ''Real Property Alterations'' on page 4. See Instructions on page 6, Part III. PART IV: DECLARATION OF PROPERTY BELONGING TO OTHERS (SPECIFY TYPE BY CODE NUMBER) Report conditional sales contracts that are not leases on Schedules C, D, or E 1. Leased equipment 2. Lease-purchase option equipment 3. Capitalized leased equipment Lessor's name Mailing address Lessor's name Mailing address OWNERSHIP TYPE ( ) Proprietorship Partnership Corporation Other DECLARATION BY ASSESSEE (omit cents) te: The following declaration must be completed and signed. If you do not do so, it may result in penalties. I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, including accompanying schedules, statements or other attachments, and to the best of my knowledge and belief it is true, correct, and complete and includes all property required to be reported which is owned, claimed, possessed, controlled, or managed by the person named as the assessee in this statement at 12:01 a.m. on January 1, 2013. SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT* 05/01/2013 NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed) James Smith TITLE Owner NAME OF LEGAL ENTITY (other than DBA) (typed or printed) FEDERAL EMPLOYER ID NO. Acme Business Services 33-4578879 PREPARER'S NAME AND ADDRESS (typed or printed) TELEPHONE NO. TITLE Pete Wilson 3456 East 8th Street # Torrance, CA 90504 *Agent: See page 8 for Declaration by Assessee instructions. 800 South Victoria Ave., Ventura, CA 93009-1270 (805) 654-2181 Acme Business Services 3100 Main Street, Ste. 125 Simi Valley CA 93065-2222 123123-4646789789 4. Animals 5. Other businesses 6. Tenants, renters, farm mgt. co., etc. 7. Government-owned property Tax Obligation: A. Lessor B. Lessee YEAR OF ACQ. Costa Mesa CA 92626 YEAR OF MFG. DESCRIPTION AND LEASE OR IDENTIFICATION NO. DATE TO PURCHASE NEW THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION -1-1 35,000 17,500 84 20,003 10,000 ANNUAL RENT Kelly Plumbing PO Box 425 Johnson CA 94564 A 1 1962 1960 12312sdf 10,000 2,500 (310) 111-3132 Accountant TO BE USED AS AN ATTACHMENT TO THE ''SIGNED ORIGINAL 571-F'' AS PRINTED BY THE ASSESSOR, REVENUE AND TAATION CODE SECTION 441.5.
BOE-571-A (P1) REV. 16 (05-12) 571-A Assessor, Dan Goodwin, Ventura County 2013 AGRICULTURAL PROPERTY STATEMENT FOR 2013 (Declaration of costs and other related property information as of 12:01 A.M., January 1, 2013) RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED. FILE RETURN BY APRIL 1, 2013. NAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address) LOCATION OF THE PROPERTY (file a separate statement for each location) 3500 s Warth Street Suite 105 Fresno CA 92556 Parcel no. of this location (if known) PART I: GENERAL INFORMATION [complete (a) through (i)] a. Enter type of farm or business: b. Enter local telephone no. Cattle Ranching (805) 423-7894 FA no. (805) 423-7888 E-Mail Address (optional) james@acmebusiness.com c. Do you own the land at this location? If yes, is the name on your deed recorded as shown on this statement? Yes Yes Tax Rate Area Assessor Only d. When did you start business at this location? DATE: 05/15/1948 e. Enter location of general ledger and all related accounting records (include zip code): 1502 Main St Ste 222 f. Enter name and telephone no. of authorized person to contact at location of accounting records: Jim Smith (714) 574-3365 g. During the period of January 1, 2012 through December 31, 2012: (1) Did any individual or legal entity (corporation, partnership, limited liability company, etc.) acquire a ''controlling interest'' (see instructions for definition) in this business entity? Yes (2) If YES, did this business entity also own ''real property'' (see instructions for definition) in California at the time of the acquisition? Yes (3) If YES to both questions (1) and (2), filer must submit form BOE-100-B, Statement of Change in Control and Ownership of Legal Entities, to the State Board of Equalization. See instructions for filing requirements. h. Do you have: (1) Registered or show horses? Yes (2) Racehorses? Yes (If yes is checked, see instructions) i. Are there manufactured homes/mobilehomes located on the property? PART II: DECLARATION OF PROPERTY BELONGING TO YOU (attach schedule for any adjustment to cost) 1. Supplies (from Schedule A) 2. Animals 3. Equipment 4. Movable farm equipment and harvesters 5. Bldgs., bldg. impr., and/or leasehold impr., land impr., land/land dev. 6. Equipment out on lease, rent, or conditional sale to others 7. Construction in progress (CIP) (from Schedule B) (from Schedule C) (from Schedule D) (from Schedule E) attach schedule attach schedule If yes, indicate: Yes number currently licensed number not currently licensed 8. Other Misc Equip PART III: TREES, VINES OR PERENNIALS [see Instructions on page 6, Part III] 9. Abbreviations: planted (P), removed (R), budded (B) or grafted (G) PARCEL 800 South Victoria Ave., Ventura, CA 93009-1270 (805) 654-2181 Acme Business Services 3100 Main Street, Ste. 125 Simi Valley CA 93065-2222 CHECK ONE P R B G 42342-4564-7879-123 DATE NUMBER SPECIES VARIETY SPACING ACRES Costa Mesa CA 92626 INTER- PLANTED (omit cents) 16,700 47,000 23 71,850 1,135,260 5,700 7 5 PART IV: DECLARATION OF PROPERTY BELONGING TO OTHERS (SPECIFY TYPE BY CODE NUMBER) Report conditional sales contracts that are not leases on Schedules C, D, or E 1. Leased equipment 2. Lease-purchase option equipment 3. Capitalized leased equipment 9. Lessor's Name Mailing Address 4. Animals 5. Other businesses 6. Tenants, renters, farm mgt. co., etc. 7. Government-owned property Tax Obligation: A. Lessor B. Lessee OWNERSHIP TYPE ( ) Proprietorship Partnership Corporation YEAR OF ACQ. YEAR OF MFG. DESCRIPTION AND LEASE OR IDENTIFICATION NO. TO ANNUAL PURCHASE RENT NEW Jim's Trucking PO Box 56 Simi Valley CA 93065 A 2 1998 1997 123sa2d 25,000 3,500 DECLARATION BY ASSESSEE te: The following declaration must be completed and signed. If you do not do so, it may result in penalties. I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, including accompanying schedules, statements or other attachments, and to the best of my knowledge and belief it is true, correct, and complete and includes all property required to be reported which is owned, claimed, possessed, controlled, or managed by the person named as the assessee in this statement at 12:01 a.m. on January 1, 2013. SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT* 05/01/2013 NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed) James Smith TITLE Owner NAME OF LEGAL ENTITY (other than DBA)(typed or printed) FEDERAL EMPLOYER ID NO. Acme Business Services 33-4578879 PREPARER'S NAME AND ADDRESS (typed or printed) TELEPHONE NO. TITLE Other Pete Wilson (310) 111-3132 Accountant 3456 East 8th Street # Torrance, CA 90504 *Agent: See page 8 for Declaration by THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION Assessee instructions. -1- DATE TO BE USED AS AN ATTACHMENT TO THE ''SIGNED ORIGINAL 571-A'' AS PRINTED BY THE ASSESSOR, REVENUE AND TAATION CODE SECTION 441.5.