Form 801b - Assessor Notification Property Claimed For More Than 12 Years - 2009
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1801B
ASSESSOR NOTIFICATION
Form
PROPERTY CLAIMED FOR MORE THAN 12 YEARS
2009
SECTION 1. Notice of Intent.
SEE INSTRUCTIONS
Municipal Code:
(see pages 5 and 6)
1A. MUNICIPALITY OF ____________________________________________________________________________
Dear Assessor: Pursuant to 36 MRSA § 6653, you are hereby notifi ed that :
(applicant name)
intends to fi le an application with Maine Revenue Services for reimbursement of property tax associated with eligible
business property fi rst placed in service in Maine after April 1, 1995 for taxes assessed April 1, ____________.
1B. Claimant is a:
Corporation
Partnership
Sole Proprietor
LLC
SECTION 2. Schedule for Business Equipment Tax Reimbursement. (
Attach additional sheets if needed)
The eligible business property is situated at (street address, map & lot, account #, etc.):
________________________________________________________________________________________________
Valuation components determined by the local tax assessors establish an essential basis for taxpayers wishing to participate
in this program. I am requesting that you provide information pertaining to the assessed value for eligible business property
in Column F and relevant assessment information in Section 3 on the reverse side. Please enter the necessary information
sorted by “Number of Years Claimed” and return this schedule to me within 60 days or make this information available to
me when the tax bills are issued, whichever occurs later. I believe the following listed property constitutes eligible business
property which is eligible for reimbursement by the State of Maine.
A.
B.
C.*
D.
E.
F.
Property Description
State of Origin
Number
Original
Original
Assessed Value
Category
(if acquired
of Years
Assessment
Cost
(To be completed by
used)
Claimed
Year
local tax assessor.)
13
1. Machinery & Equipment .............
_______
__________
$ _____________
$ _____________
13
2. Furniture .....................................
_______
__________
______________
______________
13
3. Other...........................................
_______
__________
______________
______________
4. TOTALS .......................................................................................................
______________
______________
5. Value Limitation .............................................................................................................................
.75
6. Allowable Assessed Value (in column F, multiply line 4 by line 5) .................................................
______________
* Form 801B is for property claimed more than 12 years. See instructions for this form.
SECTION 3. Property Tax Information (To be completed by local tax assessor.)
Property Tax Rate ___________________ Assessed Tax $ _____________________ For Taxes Assessed April 1, ___________
Assessor Signature _______________________________ Municipality Name _______________________ Date ___________
______________________________________
____________________________________
_________________
Taxpayer (or agent) signature
Social Security number or federal EIN (see note, p.4)
Date
REV. 08/09
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