Form 800 - Business Equipment Tax Reimbursement Application 2006 printable pdf download

BUSINESS EQUIPMENT TAX

800

Form

REIMBURSEMENT

APPLICATION

*0610700*

2006

(for eligible personal property taxes paid in 2005)

Check if applicant is a:

Corporation

LLC

Application must be filed no

later than January 2, 2007.

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:

M.I.:

Last Name:

Mailing Address:

City/Town:

State:

Zip Code:

1. Consolidated application:

YES

If YES, complete lines 2, 4, 5, 6, 8a, 8b, 8c, 8d, and 9. Lines 5, 6, 8a, 8b,

8c, 8d, and 9 must reflect the total from all municipalites. Do not

complete lines 3 and 7.

If NO, complete lines 2 through 9.

2. Business Code:

3. Municipal Code:

4a. Check this box if business was started

4b. Check this box if the business also receives reimbursement

on or after April 1, 1995 ...................................

for personal property taxes under a TIF agreement (see

instructions) ............................................................................

Enter the following information for property tax payments made in calendar year 2005 based on the April 1, 2004 and/or April 1,

2005 assessments. See Instructions.

Assessed April 1, 2004

Assessed April 1, 2005

5. Original cost of eligible property ............... 5a.

5b.

6. Assessed Value ........................................ 6a.

6b.

7. Property Tax Rate ...................................... 7a mils.

7b mils.

8. Requested Reimbursement

(If Consolidation

8a.

8b.

Schedule is used, see instructions on page 4) .............

(Enter 90% of lines 8a and 8b) ................. 8c.

8d.

9. Total Reimbursement. Line 8c plus line 8d. ........................................................................ 9.

90% of tax paid on eligible property only, taking into account any early payment discounts, but exclusive of any interest, penalties or any other

charges. 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. See instructions on page 4.

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

Applicant _______________________________ Date

Number

(or business officer)

Preparer

Preparer _______________________________ Date

ID Number

Preparer Telephone Number

office use only

REV. 05/06

Form 800 - Business Equipment Tax Reimbursement Application 2006

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