Tangible Personal Property Declaration of Closed Business

Business/Rental Name*
Owner Name*
First Last
Physical Address of Business/Rental*
Street Address Address Line 2 City State ZIP Code
Was the equipment sold?*
- Yes
- No
If yes, please list the name, address and telephone number of individual who purchased equipment.*
Please list the equipment or items sold.*
Date Business Closed*
Month
Day
Year
Certification*
I certify that I am the former owner of the business listed above and that the business closed on the above date.
Electronic Signature*
This officially acts as your signature on this form.
First Last
Date*
Month
Day
Year
Phone*
Email*

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