Form 801a - Assessor Notification Property Claimed For 12 Or Fewer Years - 2009
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1
2801A
ASSESSOR NOTIFICATION
Form
PROPERTY CLAIMED FOR 12 OR FEWER YEARS
2009
Page 1
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
Date Placed in
Original
Assessed Value
(if acquired
of Years
Service
Cost
(To be completed by
used)
Claimed
(month/year)
local tax assessor.)
1. __________________________
_______
______
__________
$ _____________
$ _____________
2. __________________________
_______
______
__________
______________
______________
3. __________________________
_______
______
__________
______________
______________
4. __________________________
_______
______
__________
______________
______________
5. __________________________
_______
______
__________
______________
______________
6. __________________________
_______
______
__________
______________
______________
7. __________________________
_______
______
__________
______________
______________
8. __________________________
_______
______
__________
______________
______________
9. __________________________
_______
______
__________
______________
______________
10. __________________________
_______
______
__________
______________
______________
11. __________________________
_______
______
__________
______________
______________
12. __________________________
_______
______
__________
______________
______________
13. __________________________
_______
______
__________
______________
______________
14. __________________________
_______
______
__________
______________
______________
15. __________________________
_______
______
__________
______________
______________
* Form 801A is for property claimed 12 or fewer years. See instructions for this form.
REV. 08/09
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