Form 800 - Business Equipment Tax Reimbursement Application - 2011
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1
22011
2011
BUSINESS EQUIPMENT TAX
99
REIMBURSEMENT APPLICATION
Form 800
(page 1)
(for eligible personal property taxes paid in 2010)
*1110700*
Application must be fi led no
Check if applicant is a:
Corporation
LLC
..
.......................
later than January 3,2012.
Partnership
Sole Proprietor
...
..
-
If applicant is a corporation, partnership or LLC, enter federal EIN .....................................
Business Name:
-
-
If applicant is a sole proprietor, enter social security number ...........................................
First Name:
MI:
Last Name:
Mailing Address:
City/Town:
State:
ZIP Code:
1. Consolidated application (Is property located in two or more municipalities?)
YES
NO
(NOTE: If YES, skip lines 3 and 7. Lines 5, 6 and 8 must refl ect the total from all municipalities. If NO, complete lines 2-9.)
2. Business Code:
4a.
Check this box if the business was started on or after April 1, 1995 .....
(see instructions)
4b.
Check this box if the business also receives reimbursement for
3. Municipal Code:
(see pages 5 and 6)
personal property taxes under a TIF agreement (see instructions) ......
Enter the following information for property tax payments made in calendar year 2010 based on the April 1, 2009 and/or April 1, 2010 assessments.
See Instructions.
Assessed April 1, 2009
Assessed April 1, 2010
,
,
,
,
$
$
5. Original Cost of Eligible Property ......................... 5a.
5b.
,
,
,
,
$
$
6. Assessed Value ................................................... 6a.
6b.
.
.
7. Property Tax Rate ................................................. 7a.
mils
7b.
mils
8. Requested Reimbursement
,
,
,
,
$
$
(see instructions) ................................................. 8a.
8b.
$
,
,
9. Total Reimbursement. Line 8a plus line 8b ............................................................................................9.
Eligible property only, taking into account any early payment discounts, but exclusive of any interest, penalties or any other charges. Dated proof
of tax payment and a copy of the tax bill must be included with your claim. Requested reimbursement must exclude any portion of the property
tax payments related to property not eligible for the program. Other limitations apply. See instructions.
To reduce printing and postage costs, if you have your return done by a tax preparer and do not need the Business Equipment Tax
Reimbursement booklet mailed to you next year, check the box to the right .....................................................................................................
Applicant (or business owner) signature: Under penalties of perjury, I declare that I have examined this application and accompanying schedules and
statements and, to the best of my knowledge and belief, they are true, correct and complete. Declaration of preparer (other than applicant) is based
on all the information of which the preparer has any knowledge.
Telephone Number
/
/
Applicant ______________________________________
Date
-
-
(or business offi cer)
/
/
Preparer_______________________________________
Date
-
-
Preparer ID Number
Preparer Telephone Number
MAIL TO: MAINE REVENUE SERVICES
P.O. BOX 1064
AUGUSTA, ME 04332-1064
R
06/11
EVISED
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