2025 Personal Property Declaration Long Form

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SPACE RESERVED FOR MUNICIPALITY USE

M-PPD-L
State of CT OPM
2025 Declaration of Personal Property
Filing Requirement – This Declaration must be filed with the Assessor of the municipality where the personal property is located.
Declarations of Personal Property shall be made annually.
If you no longer own the above noted business or personal property assessed in your name last year, you do not need to complete the full
Declaration. You must return the affidavit below to the Assessor and provide information related to the name of the new owner of the
property or the date your business ceased or to where you moved the business (see the Affidavit below). Otherwise, the Assessor must
assume that you still own and are operating the business and have failed to declare your taxable personal property.
AFFIDAVIT OF BUSINESS TERMINATION OR MOVE OR SALE OF BUSINESS OR PROPERTY
I
of
at

Business or property owners name

Business Name (if applicable)

Street location in municipality
With regards to said business or property I do certify that on

Said business or property was (Please  appropriate box):

Date
 SOLD TO:

Name

Address
 MOVED TO:

Municipality and State to where business or property was moved

Address
 TERMINATED:
Attach Bill of Sale or Letter of Dissolution to this form and return it with this affidavit to the Assessor’s office

The signer is made aware that the penalty for making a false affidavit is a $500.00 fine or imprisonment for one year or both.

Signature
Print name

Penalty for late filing – The Declaration of Personal Property must be signed and delivered or postmarked to the Assessor of this
municipality no later than Monday, November 3, 2025 to avoid a 25% Penalty for failure to file.
Deadline to File: Monday, November 3, 2025

I N S T R U C T I O N S
As per CGS §12-63, the Assessor must determine the “present true and actual value” and in determining such value may use the accepted
methods of comparable sales, cost less depreciation and income capitalization.

Not all sections are applicable to every business. Please read the following instructions and complete all relevant sections.

Who Should File -

All owners of taxable personal property.
Declaration –
1. Owners of:
a. Non-Connecticut registered motor vehicles
b. Horses, ponies and thoroughbreds
c. Mobile manufactured home not assessed as real estate
2. Businesses, occupations, farmers, and professionals
need to complete: (Commercial and cost information is not
open to public inspection)
•
Business Data (page 3).
•
Lessee’s Listing Report (page 4).
•
Disposal, Sale or Transfer of Property Report (page 4).
•
Taxable Property Information (pages 5-7).
•
Sign the Declaration of Personal Property Affidavit on
page 8.
3. Lessors need to complete: (Commercial and cost information
is not open to public inspection)
•
Business Data (page 3).
•
Lessor’s Listing Report (page 3).
•
Disposal, Sale or Transfer of Property Report (page 4).
•
Taxable Property Information (pages 5-7).
•
Sign the Declaration of Personal Property Affidavit on
page 8.
Filing Requirements –
1. The Declaration of Personal Property must be filed annually
on or before November 1 (or the Monday following if
November 1 falls on Saturday or Sunday per CGS §12-42).
2. A Declaration of Personal Property not filed will result in a
value determined by the Assessor from the best available
information (CGS §12-53b).
3. Declarations filed with “same as last year” are insufficient
and shall be considered an incomplete Declaration.
4. Pursuant to CGS §12-81(79) tangible personal property older
than 10 years and with an original value of not more than
$250 is exempt. This exemption shall not be applied for the
first ten full assessment years following the assessment year
in which the property was acquired. Complete “Detailed
Listing of Assets Original Value ≤ $250” report on Page 4.
Also list total value of such exempt assets in “Reconciliation of
Fixed Assets” box on Page 6.
Penalty of 25% is applied –
1. When no Declaration is filed or a Declaration is not signed, a
25% penalty is applied to the assessment. [See 2. under
Filing Requirements.]
2. When Declarations are submitted after November 1 [See 1.
under Filing Requirements] and an extension has NOT been
granted (see Extensions) a 25% penalty is applied to the
assessment. Returns mailed in must have a postmark (as
defined in CGS §Sec 1-2a) of November 1 [See 1. under
Filing Requirements.] or before.
3. When an extension is granted (see Extensions) and the
Declaration is not filed by the extension deadline, a 25%
penalty is applied to the assessment.
4. When omitted property is discovered, the 25% penalty is
applied to the difference in the assessed value as determined
by the results of the discovery and the assessment as
determined by the originally filed Declaration.
Exemptions-
1. On page 7, check the box adjacent to the exemption you are
claiming.
2. Several exemptions require an additional application in
order to receive that exemption. Please request the form
number noted from the Assessor’s Office. The Manufacturers
Machinery & Equipment Exemption Claim form and its
itemized lists for Code 13 property may be requested if not
included with this Declaration.
3. The extension to file the Declaration of Personal Property, if
granted, may not apply to all required exemption applications
and may require a late filing fee. Check with the Assessor.
Signature Required –
1. The owners shall sign the Declaration (page 8).
2. The owner’s agent may sign the Declaration. In which case
the Declaration must be duly sworn to or notarized.
3. Corporate officers signing for their corporations must have the
returns properly sworn to or notarized; or provide the
Assessor with a statement bearing the corporate seal and
signed by the corporate secretary setting out the office held by
the signer of the Declaration and dates office held.
Extension –
The Assessor may grant a filing extension for good cause
(CGS §12-42 &12-81K). If a request for an extension is
needed, you must request the filing extension in writing
on or before November 1, 2025.
Audit –
The Assessor is authorized to audit Declarations within three
(3) years of the date of the required filing. Substantial
penalties are applicable if such an audit reveals property not
declared as required by law (CGS §12-53).

Make Copies of Completed Declaration
for Your Records Before Filing

Example of how to complete the tables on pages 5 and 6

#16 - Furniture, fixtures and equipment

Assessor’s
Use Only
How should the following be declared?

Year
Ending
Original cost, installation
& transportation
%
Good
Depreciated Value

June 2024, you bought a desk for $800 and a chair
for $200. You have a filing cabinet and printer that
you bought 10 years ago for $2000 that is being
used in your business.
See the table to the right for the answer.

10-1-25

95%

10-1-24
1000
90%
900

10-1-23

80%

10-1-22

70%

10-1-21

60%

10-1-20

50%

10-1-19

40%

Prior Yrs
2000
30%
600

Total
3000
Total
1500

#16
1500

Page 2

2025 DECLARATION OF PERSONAL PROPERTY
Commercial and financial information is not open to public inspection

List or Account #:

Assessment date October 1, 2025
Owner’s Name:

Required return date November 3, 2025
DBA:

Location (street & number)
BUSINESS DATA For businesses, occupations, professions, farmers, lessors Answer all questions 1 through 12, writing N/A on lines that are not applicable.

1. Direct questions concerning return to -

2. Location of accounting records -
Name

Address

Town/State/Zip

Phone / Fax
( )
/ ( )

( )
/ ( )
E-mail

3. Description of Business

4. How many employees work in your facilities in this municipality only?

5. Date your business began in this municipality?

6. How many square feet does your firm occupy at your location(s) in this municipality?
Sq. ft.
Own  Lease 
7. Type of ownership:
 Corporation  Partnership  LLC  Sole proprietor  Other-Describe
8. Type of business:
 Manufacturer  Wholesale  Service  Profession  Retail/Mercantile  Tradesman  Lessor

 Other-Describe

IRS Business Activity Code

Yes
No
9. In the last 12 months was any of the property included in this Declaration located in another Connecticut municipality
for at least 3 months? If yes, identify by specific months, code, cost, and location(s).
.
.

10. Are there any other business operations that are operating from your address here in this municipality?
If yes, give name and mailing address.
.
.
11. Do you own tangible personal property that is leased or consigned to others in this municipality?
If yes, complete Lessor’s Listing Report (below)
.
.
12. Did you have in your possession on October 1st any borrowed, consigned, stored or rented property?
If yes, complete Lessee’s Listing Report (page 4)
.
.

LESSOR’S LISTING REPORT In order to avoid duplication of assessments related to leased personal property, the following must be completed by
Lessors: (Please note that property under conditional sales agreements must be reported by the lessor.) Computerized filings are acceptable if all information is
reported in prescribed format.

Lessee #1
Lessee #2
Lessee #3
Name of Lessee

Lessee’s address

Physical location of equipment

Full equipment description

Is equipment self-manufactured?
Yes  No 
Yes  No 
Yes  No 
Acquisition date

Current commercial list price new

Has this lease ever been purchased,
assumed or assigned?
Yes  No 
Yes  No 
Yes  No 
If yes, specify from whom

Date of such purchase, etc.

If the original asset cost was changed
by this transaction, give details.

Type of lease
Operating Capital Conditional Sale
Operating Capital Conditional Sale
Operating Capital Conditional Sale
Lease Term – Begin and end dates

Monthly contract rent

Monthly maintenance costs if included
in the monthly payment above

Is equipment declared on the Lessor’s
or the Lessee’s manufacturing
exemption application?
Yes 
No 
Lessor 
Lessee 
Yes 
No 
Lessor 
Lessee 
Yes 
No 
Lessor 
Lessee 

Page 3

List or Account#:

Assessment date October 1, 2025
Owner’s Name:

Required return date November 3, 2025

LESSEE’S LISTING REPORT - Pursuant to CGS §12-57a all leased, borrowed, consigned, loaned, rented, or stored personal property not owned by you
but in your possession as of the assessment date must be included on this form. Failure to declare, in the form and manner as herein prescribed, shall result in
the presumption of ownership and subsequent tax liability plus penalties. Property you do not lease that may be in your possession and must be reported
includes (but is not limited to) dumpsters, gas/propane tanks, vending machines, water coolers, coffee machines.
Yes

No

Did you dispose of any leased items that were in your possession on October 1, 2024? If
yes, enter a description of the property and the date of disposition in the space to the right.



Did you acquire any of the leased items that were in your possession on October 1, 2024?
If yes, indicate previous lessor, item(s) and date(s) acquired in the space to the right.


 Is the cost of any of the equipment listed below declared anywhere else on this Declaration? If yes, note year in the ‘Year Included’ row and list
cost in the ‘Acquisition Cost’ row.

Lease #1
Lease #2
Lease #3
Name of Lessor

Lessor’s address

Phone Number

Lease Number

Item description /
Model #

Serial #

Year of manufacture

Capital Lease
Yes  No 
Yes  No 
Yes  No 
Lease Term –
Beginning/End

Monthly rent

Acquisition Cost

Year Included

DISPOSAL, SALE OR TRANSFER OF PROPERTY REPORT
Disposal, sale or transfer of property – If you disposed of, sold or transferred a portion of the property included in last year’s filing, complete the Detailed Listing
of Disposed Assets Report And Reconciliation Of Fixed Assets on page 6. If you no longer own the business noted on the cover sheet you do not need to
complete this Declaration. You must, however, return to the Assessor this Declaration along with the complete AFFIDAVIT OF BUSINESS CLOSING OR MOVE OF
BUSINESS OR SALE OF BUSINESS FOUND in this return. DO NOT INCLUDE DISPOSALS IN THE TAXABLE PROPERTY REPORTING SECTION.
DETAILED LISTING OF DISPOSED ASSETS (COPY AND ATTACH ADDITIONAL SHEETS IF NEEDED)
Removal Date
Code #
Description of Item
Acquisition Date
Acquisition Cost

DETAILED LISTING OF ASSETS HAVING AN ORIGINAL VALUE LESS THAN $250 (COPY AND ATTACH ADDITIONAL SHEETS IF NEEDED)
Pursuant to CGS §12-81(79) – Listing of assets purchased prior to 10/1/2015 with an original value less than or equal to $250
Description of Item
Acquired Date
Acquisition Cost

TAXABLE PROPERTY INFORMATION
1)
All data reported should be:
a)
Actual acquisition costs including any additional charges for
transportation and installation by year for each type of property
described. These costs, less the standard depreciation as shown
on the form will determine the net depreciated value.
b)
Include all assets that may have been fully depreciated, written
off, or charged to expense but are still owned. Do not include
disposed assets.
c)
For used assets purchased where the installed historical cost is
not known, the purchase price would be the depreciated value.
2)
Reports are to be filed on an assessment year basis of October 1.
Acquisitions between October 2 and December 31 apply to the new
year. (i.e. acquisition made October 30, 2024 are reported on the
following year’s Declaration).
3)
Computerized filings are acceptable if all information is reported in
prescribed format.
4)
Do not include disposed assets. Disposals are used to reconcile last
year’s reporting with this year’s reporting.

Page 4

List or Account #:

Assessment date October 1, 2025
Owner’s Name:

Required return date November 3, 2025
# 9 – Motor Vehicles: Unregistered motor vehicles & vehicles
garaged in Connecticut but registered in another state

#10 – Manufacturing Machinery & Equipment not eligible under
CGS §12-81 (76) (MM&E) for exemption

Assessor’s
Use Only

VEHICLE 1
VEHICLE 2
VEHICLE 3

Year
Ending
Installed historical cost
including transportation
%
Good
Depreciated Value

Year

Make

10-1-25

95%

Model

10-1-24

90%

VIN

10-1-23

80%

Length

10-1-22

70%

Weight

10-1-21

60%

Purchase $

10-1-20

50%

Date

10-1-19

40%

Prior Yrs

30%

# 9

MSRP $

Total

#10

#11 – Horses and Ponies

#12 – Commercial Fishing Apparatus

#1
#2
#3

Year
Ending
Installed historical cost
including transportation
%
Good
Depreciated Value

Breed

Registered

10-1-25

95%

Age

10-1-24

90%

Sex

10-1-23

80%

Quality

10-1-22

70%

Breeding

10-1-21

60%

Show

10-1-20

50%

Pleasure

10-1-19

40%

Racing

Prior Yrs

30%

#11

Value

Total

#12

#13 – Manufacturing Machinery & Equipment eligible for
exemption under CGS §12-81(76) – Must file exempt claim.

#14 – Mobile Manufactured Homes if not currently assessed
as real estate

Year
Ending
Installed historical cost
including transportation
%
Good
Depreciated Value

#1
#2
#3

Year

10-1-25

95%

Make

10-1-24

90%

Model

10-1-23

80%

ID Number

10-1-22

70%

Length

10-1-21

60%

Width

10-1-20

50%

Bedrooms

10-1-19

40%

Baths

Prior Yrs

30%

#13

Total

Value

#14

#16 - Furniture, Fixtures and Equipment

Year
Ending
Installed historical cost
including transportation
%
Good
Depreciated Value

10-1-25

95%

10-1-24

90%

10-1-23

80%

10-1-22

70%

10-1-21

60%

10-1-20

50%

10-1-19

40%

Prior Yrs

30%

Total

#16

#17 – Farm Machinery

#18 – Farm Tools

Year
Ending
Installed historical cost
including transportation
%
Good
Depreciated Value

10-1-25

95%

10-1-25

95%

10-1-24

90%

10-1-24

90%

10-1-23

80%

10-1-23

80%

10-1-22

70%

10-1-22

70%

10-1-21

60%

10-1-21

60%

10-1-20

50%

10-1-20

50%

10-1-19

40%

10-1-19

40%

Prior Yrs

30%

Prior Yrs

30%

#17

Total

#18

Page 5

List or Account #:

Assessment date October 1, 2025
Owner’s Name:

Required return date November 3, 2025
#19 – Mechanics Tools

# 20 -- Electronic Data Processing Equipment

Year
Ending
Installed historical cost
including transportation
%
Good
Depreciated Value

In accordance with Section 168 IRS Codes
Computers Only

10-1-25

95%

10-1-24

90%

Year
Ending
Installed historical cost
including transportation
%
Good
Depreciated Value

10-1-23

80%

10-1-22

70%

10-1-25

95%

10-1-21

60%

10-1-24

80%

10-1-20

50%

10-1-23

60%

10-1-19

40%

10-1-22

40%

Prior Yrs

30%

Prior Yrs

20%

#19

Total

#20

#21a Telecommunications Equipment Not Technologically
Advanced

#21b Telecommunications Equipment Technologically
Advanced

Year
Ending
Installed historical cost
including transportation
%
Good
Depreciated Value

10-1-25

95%

10-1-25

95%

10-1-24

90%

10-1-24

80%

10-1-23

80%

10-1-23

60%

10-1-22

70%

10-1-22

40%

10-1-21

60%

Prior Yrs

20%

10-1-20

50%

Total

10-1-19

40%

Prior Yrs

30%

Total

21a and 21b Total

#21

#22 – Cables, Conduits, Pipes, Class I Renewables, etc.

# 23 – Average Quantity of Supplies Consumed

Year
Ending
Installed historical cost
including transportation
%
Good
Depreciated Value

The average is the total amount expended on supplies since
October 1, 2024 divided by the number of months in business
since October 1, 2024.

10-1-25

10-1-24

Year
Ending
Total Expended
# of
Months
Average Monthly

10-1-23

10-1-22

9-30-25

10-1-21

10-1-20

10-1-19

If you are expensing items under IRS Code 178 (which allows you to
fully deduct qualifying property), do not include them in Code 23. List
them in the proper category where they would normally belong if they
were not expensed under Code 178.

Prior Yrs

Total

#22

Check here if a FERC or PURA regulated utility

#23

#24a – All Other Goods, Chattels and Effects

#24b -- Rental Entertainment Medium

Year
Ending
Installed historical cost
including transportation
%
Good
Depreciated Value

10-1-25

95%

10-1-25

95%

10-1-24

90%

10-1-24

80%

10-1-23

80%

10-1-23

60%

10-1-22

70%

10-1-22

40%

10-1-21

60%

Prior Yrs

20%

10-1-20

50%

Total

10-1-19

40%

# of video tapes

# of DVD movies

Prior Yrs

30%

# of music CD’s

# of video games

Total

24a and 24b Total

#24

RECONCILIATION OF FIXED ASSETS

Assets declared last October 1, 2024

Assets disposed of since last October 1, 2024*
-

Assets added since last October 1, 2024
+

Assets originally valued ≤ $250 & over 10 years old **
-

Assets declared this year October 1, 2025

Amount of expensed equipment last year

Capitalization Threshold

*Complete Detailed Listing of Disposed Assets –page 4

Page 6

** Assets Original Value ≤ $250 – page 4

2025 DECLARATION OF PERSONAL PROPERTY – SUMMARY SHEET
Commercial and financial information is not open to public inspection.
List or Account #:

Assessment date October 1, 2025
Required return date November 3, 2025
Owner’s Name:
This Declaration of Personal Property must be signed,
and delivered or postmarked by
Monday, November 3, 2025 to
Assessor of the municipality
where property is located

DBA:

Mailing address:

Town/State/Zip:

Location (number and street)
ASSESSOR’S
USE ONLY
Property Code and Description
Net Depreciated
Value pages 5 & 6 Code ASSESSMENTS
#9 - Motor Vehicles: Unregistered motor vehicles (e.g. motor homes, tent or truck campers, travel trailers, snowmobiles, utility
trailers, passenger cars, tractors, off-road construction vehicles, etc.) including any vehicle garaged in Connecticut but registered in
another state. Snowmobiles, ATV’s, or residential utility trailers used exclusively for personal use are not to be reported, CGS §12-
81 (82).

#10 – Industrial Manufacturing Machinery & Equipment: Industrial manufacturing machinery and equipment (e.g., tools, dies,
jigs, patterns, etc.). Include air and water pollution control equipment. Not included under CGS §12-81 (76).

#10

#11 Horses And Ponies: Describe your horses and ponies. A $1,000 assessment exemption per animal will be applied. If you are
a farmer, the exemption may be 100% provided Form M-28 is filed with and approved by the Assessor.

#11

#12 - Commercial Fishing Apparatus: All fishing apparatus exclusively used by a commercial fisherman in the business (e.g.,
fishing poles, nets, lobster pots, fish finders, etc.). A $500 value exemption will be applied.

#12

#13 –Manufacturing Machinery & Equipment: Manufacturing machinery and equipment used in manufacturing; used in research
or engineering devoted to manufacturing; or used for the significant servicing or overhauling of industrial machinery or factory
products and eligible for exemption under CGS §12-81 (76).

#13

#14 Mobile Manufactured Homes: if not currently assessed as real estate

#14

#16 – Furniture, Fixtures and Equipment: Furniture, fixtures and equipment of all commercial, industrial, manufacturing,
mercantile, trading and all other businesses, occupations and professions. Examples: desks, chairs, tables, file cabinets,
typewriters, calculators, copy machines, telephones (including mobile telephones), telephone answering machines, facsimile
machines, postage meters, cash registers, moveable air conditioners, partitions, shelving display racks, refrigerators, freezers,
kitchen equipment, etc.

#16

#17 - Farm Machinery: Farm machinery (e.g., tractors, harrows, brush hogs, hay bines, hay rakes, balers, corn choppers, milking
machines, milk tanks, coolers, chuck wagons, dozers, back hoes, hydroponic farm equipment, aquaculture equipment, etc.), used in
the operation of a farm.

#17

#18 - Farming Tools: Farm tools (e.g., hoes, rakes, pitch forks, shovels, hoses, brooms, etc.).

#18

#19 - Mechanics Tools: Mechanics tools (e.g., wrenches, air hammers, jacks, sockets, etc.).

#19

#20 - Electronic Data Processing Equipment: Electronic data processing equipment (e.g., computers, printers, peripheral
computer equipment, and any computer-based equipment acting as a computer as defined under Section 168 of the IRS Code of
1986, etc.). Bundled software is taxable and must be included.

#20

#21 - Telecommunications Equipment: Excluding furniture, fixtures, and computers. 21a includes cables, conduits, antennae,
batteries, generators or any equipment not deemed technologically advanced by the Assessor. #21b includes controllers, control
frames, relays switching and processing equipment or other equipment deemed technologically advanced by the Assessor.

#21

#22 - Cables, conduits, pipes, poles, towers (if not currently assessed as real estate), underground mains, wires, turbines,
Class I Renewables, Cylinder and other Tanks of gas, heating, or energy producing companies, telephone companies, water and
water power companies. Include items annexed to the ground (e.g., hydraulic car lifts, gasoline holding tanks, pumps, truck scales,
etc.), as well as property used for the purpose of creating or furnishing a supply of water (e.g. pumping stations).

#22

#23 – Average Quantity of Supplies Consumed: The average monthly quantity of supplies normally consumed in the course of
business (e.g., stationery, post-it notes, toner, computer disks, computer paper, pens, pencils, rulers, staplers, paper clips, medical
and dental supplies and maintenance supplies, etc.).

#23

#24 – All Other Goods, Chattels and Effects: Any other taxable personal property not previously mentioned, or which does not
appear to fit into any of the other categories. (e.g., video tapes, vending machines, pinball games, video games, signs, billboards,
coffee makers, water coolers, leasehold improvements and construction in progress (CIP).

#24

Total Net Depreciated and Assessment – all codes #9 through #24
Subtotal >

#25 – Personal Property Penalty for failure to file as required by statute – 25% of assessment
#25
Exemption - Check box adjacent to the exemption you are claiming:

 I – Farming Tools - $500 value  I – Horses/ponies $1000 assessment per animal  I – Mechanic’s Tools - $500 value

 K – Municipal Leased  M – Commercial Fishing Apparatus - $500 value

All of the following exemptions require a separate application and/or certificate to be filed with the Assessor by the required
return date:

 G & H – Distressed Municipality/Enterprise Zone/Enterprise Corridor Zone - Exemption application M-55 required annually

 I – Farm Machinery $100,000 assessment - Exemption application M-28 required annually

 J – Class I Renewable - Exemption Application M-44 required.

 J – Water Pollution or Air Pollution control equipment – Connecticut DEEP certificate required – provide copy

 U – Manufacturing Machinery & Equipment Claim Form - Exemption claim required annually

Assessor’s Final Assessment Total >

Page 7

List or Account #:

Assessment date October 1, 2025
Owner’s Name:

Required return date November 3, 2025

Notes:

The Declaration of Personal Property must be signed and delivered or postmarked to the Assessor of this municipality no
later than Monday, November 3, 2025 to avoid a 25% Penalty for failure to file.
Page 8
DECLARATION OF PERSONAL PROPERTY AFFIDAVIT
THIS FORM MUST BE SIGNED (AND IN SOME CASES WITNESSED) BEFORE IT MAY BE FILED WITH THE ASSESSOR.
AVOID PENALTY – IMPROPERLY SIGNED DECLARATIONS REQUIRE A 25% PENALTY
COMPLETE SECTION A OR SECTION B

Section A

OWNER: I DO HEREBY declare under penalty of false statement that all sections of this Declaration have been
completed according to the best of my knowledge, remembrance, and belief; that it is a true statement of all my
personal property liable to taxation; and that I have not conveyed or temporarily disposed of any estate for the
purpose of evading the laws relating to the assessment and collection of taxes as per CGS §12-49.
SEE PAGE TWO (2) FOR SIGNATURE REQUIREMENTS.

CHECK ONE

OWNER

PARTNER


CORPORATE OFFICER

MEMBER

Owner
Signature

Dated

Signature/Title

Print or type name

Section B

AGENT: I DO HEREBY declare under oath that I have been duly appointed agent for the owner of the property listed herein and that I
have full authority and knowledge sufficient to file a proper Declaration for him in accord with the provisions of §12-50 C.G.S.

Agent’s
Signature

Dated

Agent’s Signature /Title

Print or type agent’s name

AGENT SIGNATURE MUST BE WITNESSED

Witness of agent’s sworn statement

Subscribed and sworn to before me

Dated

Assessor or staff member, Municipal Clerk, Justice of the Peace, Notary or Commissioner of Superior Court

Check Off List:
For questions concerning this Declaration, contact the Assessor’s Office at:
 Read instructions on page 2

 Complete appropriate sections
SPACE RESERVED FOR
MUNICIPALITY ADDRESS
 Complete exemption applications

 Sign & date as required on page 8

 Make a copy for your records

 Return by November 3, 2025