BUSINESS PERSONAL PROPERTY RENDITION Tax …

1 For assistance, please refer to the instructions for this PERSONAL PROPERTY RENDITIONCONFIDENTIALJANUARY 1, 2018*0000000*AccountTax Year*2018*Tax Form*NEWPP130*Return to:Form Facsimile(11/17)Harris County Appraisal DistrictBusiness & Industrial PROPERTY Box 922007 Houston, TX 77292-2007 Account Number:Part 1. PROPERTY Owner Name, BUSINESS Name, Address, Phone and Physical Location or Situs [Required] PROPERTY AddressAgent's Name:0000000 BUSINESS OwnerBusiness NameMailing AddressSample Harris CountyBrent Tomlinson (DBA Tomlinson Hardware)iFile Number:12345678(713) 111-2222 Phone:Agent's ID#:2525 W. Ellington Drive, Houston, TX 55555-1234444 Hardington Lane, Houston, TX 55555-1234 Part 2. BUSINESS Information: Please address all that apply. Optional, but very was closed,sold ormovedon New owner name, address, and phone (if sold)New location (if moved)10/12/2015123 Widget Feet Occupied32,000 Sales Tax Permit Number5554321We manufacture and sell DescriptionBusiness Start Date at Location01/01/2003If the BUSINESS closed, were assets still in place as of Jan 1?

2 YNBusiness TypeManufacturingWholesaleRetailServiceT he BUSINESS owned no taxable assets in Harris County as of Jan 1 This is a new BUSINESS or location for the above tax yearOwnership TypeIndividualPartnershipCorporationXOth er:By checking this box, I affirm that the information contained in the most recent RENDITION statement filed for a prior tax year (the _____ tax year) continues to be complete and accurate for the current tax year. [If checked, you may skip to Part 6. "Signature and Affirmation"]Part 3. Affirmation of Prior Year RENDITION : (Check only if applicable and your assets were exactly the same as the prior RENDITION form).InventorySuppliesRaw MaterialsWork in ProcessFurniture & FixturesMachinery & EquipmentComputersMiscellaneousLocation (if different from above)Describe Miscellaneous AssetsXXXXXXPart 4.

3 Description of Assets: A description of assets is required unless you checked Part 3 of this form. Please check all that 5. Market Value: What do you estimate to be the total market value of your BUSINESS assets? [Required, unless you checked Part 3 of this form.]Under $20,000$20,000 or moreX[If "Under $20,000" is checked, Schedule A is optional as long as a general description of the PROPERTY by type or category has been provided in Part 4.][If "$20,000 or more" is checked, you must complete Schedules B/C/D.] PERSONAL PROPERTY You Manage or Control as a Fiduciary ( PROPERTY owner's Name, Address, Phone, desc) [Optional if Part 3 is checked]Brad Smith, 123 Main, Houston TX 11223, (713) 555-1212, computersBill Ellington, 321 Oak, Houston TX 55443 (713) 555-2323, furniture, various items3rd party here4th party herePart 6.

4 Sign and Date Form: This form must be signed and dated. By signing this document, you attest that the information contained on it is true and correct to the best of your knowledge and Name:Company Name:Notarization: Complete if signer is not a secured party, or owner, employee, or officer of the company or affiliated AND SWORN BEFORE ME THIS:day of, 2018 Notary Public SignatureSEALS ample Harris CountyBill TrentonVice PresidentSignatureTitle:Email 111-2222 Phone if you are filling out this form as:Owner / EmployeeAuthorized AgentSecured PartyXFiduciaryStateContinue to Schedule B (Optional if Part 3 is checked OR if 'Under $20,000' is checked in Part 5)If you make a false statement on this form, you could be found guilty of a Class A misdemeanor or state jail felony under Section , Penal Rev 2017-11 Form Facsimile Page 1 of 42018 Name:Sample Harris County (Brent Tomlinson)Account #: 0000000 Tax YearMy inventory is located in an active Foreign Trade ZoneXMy inventory involves dealer retail inventory involves freeport inventory involves interstate/foreign commerce timely filed for a September 1 inventory date by July :XLower of your cost or market valueOtherFIFOLIFO - ReserveReplacement CostOriginal CostInventory Basis.

5 PERSONAL PROPERTY VALUED AT $20,000 OR MORESCHEDULE B: Furniture, fixtures, machinery, equipment, computersTotal and group (by type/category and year acquired) all furniture, fixtures, machinery, equipment and computers (new or used) still in possession on Jan 1. Items received as gifts are to be listed in the same manner. Enter Vehicles, Trailers and Special Equipment on form If needed, attach additional sheets OR a computer generated listing of the information ** PROPERTY description by type/categoryNew/Used *Est ofQuantityGood faith estimateof market value ** (or)Orig. Cost **(and)Year Acquired **FID**Computers (PC & Peripherals)DELL InspironN 1,500 1,5002017 TotalsComputerN2016 1,199 Misc PCsN 15 7,500 1,199 7,5002016 TotalsComputersN2012 5,311 Lap top computerN2012 2,338 7,6492012 TotalsComputerN2006 3,502 3,5022006 Totals$12,350$9,000 Total for Computers (PC & Peripherals)

6 Furniture and FixturesFurnitureN2015 510 5102015 TotalsF & F 4,500 4,5002013 TotalsChairs and plantsN2012 721 Off Depot office furnishingsN2012 295 Office Depot office furnishingsN 1,000 Office furnitureN2012 360 Sam's Club office furnishingsN2012 75 1,451 1,0002012 Totals$1,961$5,500 Total for Furniture and FixturesTWForms-TXHARBPP Rev 2017-11 Form Facsimile Page 2 of 4 Machinery and EquipmentEquipmentN2015 3,702 3,7022015 TotalsStorage tanksN2014 2,298 2,2982014 TotalsStorage tankN2010 1,299 Storage tankN2010 1,337 Storage tankN2010 2,080 Storage tankN2010 1,394 6,1102010 Totals4 storage tanksN 4,800 Fork liftN2009 1,800 Oil storage tankN2009 1,099 2,899 4,8002009 Totals3 storage tanksN2008 3,4006 storage tanksN2008X 24,000 PROPERTY address or address where taxable: 123 old tank avenueTrailerN 500 27,400 5002008 TotalsOil storage tankN2005 2,130 Spray tankN2005 1,822 Tank trailerN2005 975 Trailer equipmentN2005 2,113 7,0402005 Totals$49,449$5,300 Total for Machinery and Equipment$19,800$63,760 FMVI tems : 29 Totals for ALL CategoriesCOST$83,560 GRAND TOTALFMV + COST* Optional** If you provide an amount in the "good faith estimate of market value", you need not complete a "original cost" and "year acquired.

7 " "Good faith estimate of market value" is not admissible in subsequent protest, hearing, appeal, suit, or other proceeding involving the PROPERTY except for: (1) proceedings to determine whether a person complied with RENDITION requirement; (2) proceedings for determination of fraud or intent to evade tax; or (3) a protest under Tax Code Section ** If you provide an amount in a "original cost" and "year acquired", you need not complete "good faith estimate of market value".** If the PROPERTY is located or taxable at a different location, check the ' ' box and include the PROPERTY address or address where taxable.** If the PROPERTY is managed or controlled as a Fiduciary, check the 'FID' box and list the owner's name and address on page Rev 2017-11 Form Facsimile Page 3 of 4 SCHEDULE C: INVENTORY, RAW MATERIALS, WORK IN PROCESS AND SUPPLIESList and group all taxable inventories by type of PROPERTY , (example: inventory, raw materials, work in process, finished goods) as well as supplies.

8 If needed, attach additional sheets OR a computer generated listing of the information ** PROPERTY description by type/categoryEst. ofQuantityGood faith estimateof market value * (or)Orig. Cost **(and)Year Acquired **FID**Inventory Held for SaleInventory2017 25,000 25,0002017 TotalsRaw MaterialsRaw materials decription2017 11,250 11,2502017 TotalsSuppliesVarious supplies2017 12,750 12,7502017 Totals$49,000 Items : 3 Totals for ALL CategoriesCOST* If you provide an amount in the "good faith estimate of market value", you need not complete a "original cost" and "year acquired." "Good faith estimate of market value" is not admissible in subsequent protest, hearing, appeal, suit, or other proceeding involving the PROPERTY except for: (1) proceedings to determine whether a person complied with RENDITION requirement; (2) proceedings for determination of fraud or intent to evade tax; or (3) a protest under Tax Code Section ** If you provide an amount in a "original cost" and "year acquired", you need not complete "good faith estimate of market value".

9 ** If the PROPERTY is located or taxable at a different location, check the ' ' box and include the PROPERTY address or address where taxable.** If the PROPERTY is managed or controlled as a Fiduciary, check the 'FID' box and list the owner's name and address on page D: PROPERTY UNDER BAILMENT, LEASE, CONSIGNMENT, OR OTHER ARRANGEMENTList the name and address of each PROPERTY owner of taxable PROPERTY that is in your possession or under your management on January 1 by bailment, lease, consignment, or other arrangement. If needed, attach additional sheets OR a computer generated listing of the information PROPERTY DescriptionProperty Owner's Name and AddressContractNumber *Selling Price if stated in lease *Year Acquired *AnnualRent *Leased, loaned .. from othersLeased ditch diggerBob Ellington123 Park Way(214) 555-1212$5002017$14,000 Total Number of Items: 1* OptionalTWForms-TXHARBPP Rev 2017-11 Form Facsimile Page 4 of 4 Name.

10 :Address ..:Account #..:Additions & Deletions - Current YearTAX YEAR 2018 Sample Harris County (Brent Tomlinson)444 Hardington Lane - Houston, TX 55555-12340000000 - (VEH Account # 9999999)StateCountyTexasHarrisASSESSOR USE ONLYADDITIONS DURING THE CURRENT REPORTING YEAR - 2017 ItemNumberYear AcquiredNewUsedCostCLASSLIFEYEARS%GOODDE PRFACTORRCLNDFMVC omputers (PC & Peripherals) 5 2,500 2017 DELL Inspiron 1,500 Additions for Computers (PC & Peripherals)$2,500$1,500 ItemNumberYear AcquiredNewUsedCostCLASSLIFEYEARS%GOODDE PRFACTORRCLNDFMVI nventory Held for Sale 1 25,000 2017 InventoryAdditions for Inventory Held for Sale$25,000 ItemNumberYear AcquiredNewUsedCostCLASSLIFEYEARS%GOODDE PRFACTORRCLNDFMVL eased, loaned .. from others 6 14,000 2017 Leased ditch diggerOwner Name : Bob EllingtonAddress : 123 Park WayPhone : (214) 555-1212 Payment: Selling Price: Contract # (if applicable): $500 $14,000 Lease InformationAdditions for Leased, loaned.