PERSONAL PROPERTY ASSESSMENT AMENDMENT FORM
Please mail this form and all correspondence to:
THOMAS J. CAPELLA
ASSESSOR, JEFFERSON PARISH
200 DERBIGNY STREET SUITE 1100
GRETNA, LA 70053
ATTN: PERSONAL PROPERTY DEPTARTMENT
Please correct bill/ notice/ parcel number
____________________________ --- _______________________________________________________
Parcel/Bill/Assessment/Notice # Business Name
for the year(s) _______.
_________________________________________ _________________________
Signature of Business Owner or Authorized Agent NOTARY PUBLIC
_________________________________________
Business Owner/Authorized Agent Telephone #
Please have the following completed along with this letter:
1. HAVE THIS FORM NOTARIZED
2. FORM(S) FILLED OUT, SIGNED AND DATED
If additional explanation is required please attach a separate letter.
*ONCE ALL REQUIREMENTS ARE MET, YOU SHOULD RECEIVE A CORRECTED BILL IN ABOUT 4 - 6 WEEKS*
If you have any questions, please contact our Personal Property Department at (504)362-4100.
---FOR OFFICE USE---
DATE SENT
JPAO EMPLOYEE INITIALS
CURRENT YEAR FILED?
CONFIDENTIAL: RS 47:2327. Forms filed by a taxpayer shall be
used by the assessor, the governing authority,
and Louisiana Tax Commission solely for the
purpose of administering this statute.
Legal Citation & Instructions: This report shall be filed with the
assessor of the parish indicated within forty-five days after receipt, in
accordance with RS 47:2324.
LAT 5 PERSONAL PROPERTY REPORT YEAR
RETURN TO:
THOMAS J. CAPELLA
ASSESSOR, JEFFERSON PARISH
200 DERBIGNY STREET SUITE 1100
GRETNA, LA 70053
WARD
ASSESSMENT NO.
RECAP -
NAME/ADDRESS (Indicate any Changes)
FAILURE TO ACCURATELY REPORT THE INFORMATION REQUESTED WILL RESULT
IN AN ADDITIONAL PENALTY ASSESSMENT.
NAME OF BUSINESS
TYPE OF BUSINESS
LOCATION (if different from mailing address)
OWNER/PERSON TO CONTACT BUSINESS AREA SQUARE FEET
PHONE
IMPORTANT!
• AN ITEMIZED DEPRECIATION SCHEDULE, LISTING ASSETS (INCLUDING FULLY DEPRECIATED ITEMS AND/OR EXPENSED ITEMS) MAY ACCOMPANY
THIS REPORT.
• FIRMS HAVING 10 YEAR EXEMPTION SHALL COMPLETE FORM LAT 5A AND ATTACH TO THIS FORM.
• BANKS ONLY: ATTACH TO THIS REPORT A LIST OF SHAREHOLDERS AND A COPY OF YOUR CONSOLIDATED REPORT OF CONDITION AND
CONSOLIDATED REPORT OF INCOME AS FURNISHED TO THE OFFICE OF FINANCIAL INSTITUTIONS OR TO THE COMPTROLLER OF CURRENCY AS OF
DEC. 31.
SECTION 1.
INVENTORIES/MERCHANDISE
Method of Reporting: (Check One) ______ LIFO ______ FIFO ______ COST ______ RETAIL ______ OTHER (Explain)
MERCHANDISE RAW MATERIALS
WORK IN
PROGRESS
FINISHED
GOODS
SUPPLIES TOTAL
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
GRAND TOTAL
AVERAGE
PLEASE MAKE A COPY FOR YOUR RECORDS
SECTION 2. (GROUP BY YEAR OF ACQUISITION) FURNITURE AND FIXTURES (INCLUDING FULLY DEPRECIATED ASSETS)
YEAR OF
ACQUISITION
ACQUISITION
COST
YEAR OF
ACQUISITION
ACQUISITION
COST
YEAR OF
ACQUISITION
ACQUISITION
COST
YEAR OF
ACQUISITION
ACQUISITION
COST
15 YEARS
OR OVER
SECTION 3.
(GROUP BY YEAR OF ACQUISITION)
MACHINERY AND EQUIPMENT
(INCLUDING FULLY DEPRECIATED ASSETS)
(EXCLUDE LICENSED MOTOR VEHICLES)
YEAR OF
ACQUISITION
ACQUISITION
COST
YEAR OF
ACQUISITION
ACQUISITION
COST
YEAR OF
ACQUISITION
ACQUISITION
COST
YEAR OF
ACQUISITION
ACQUISITION
COST
25 YEARS
OR OVER
SECTION 4. SECTION 5.
COMPUTER EQUIPMENT LEASEHOLD IMPROVEMENTS/ MISC. PROPERTY
YEAR OF
ACQUISITION
ACQUISITION
COST
YEAR OF
ACQUISITION
ACQUISITION
COST
ITEM
YEAR OF
ACQUISITION
ACQUISITION COST
3 YEARS
OR OVER
SECTION 6. CONSIGNED GOODS, LEASED, LOANED, OR RENTED EQUIPMENT, FURNITURE ETC.
ATTACH LIST SHOWING NAME, ADDRESS, TYPE AND AGE OF PROPERTY, MONTHLY RENTAL
_________________________________SIGNATURE AND VERIFICATION___________________________________
“I declare under the penalties for filing false reports (R.S. 14:125; up to 500.00 fine or imprisonment for one year or both, plus additional penalties
defined in Act 2330B of the 1989 Regular Session) that this return has been examined by me and to the best of my knowledge and belief is a true,
correct and complete return.” “This return must be signed by the taxpayer, authorized officer or partner and by the preparer.”
_________________________________________________ ___________ _________________________________________________ ___________
SIGNATURE OF TAXPAYER DATE SIGNATURE OF PREPARER DATE
