Form 800 - Business Equipment Tax Reimbursement Application printable pdf download

BUSINESS EQUIPMENT TAX

800

011071000

Form

REIMBURSEMENT

APPLICATION

Application must be filed no

Check if applicant is a:

Corporation

LLC

later than April 1, 2002.

Partnership

Sole Proprietor

If applicant is a corporation, partnership or LLC, enter federal ID number .......................

Business Name

If applicant is a sole proprietor, enter Social Security number ...........................................

Your First Name

Initial

Your Last Name

Mailing Address

City/Town

State

ZIP

1. Consolidated application:

YES

(If yes, complete lines 2, 4, 5, 6, and 8. Lines 5, 6, and 8 must reflect

the total from all municipalities. Do not complete lines 3 and 7.)

(If no, complete lines 2 through 8.)

2. Business Code

3. Municipal Code

4. Check this box if business was started on or after April 1, 1995

Enter the following information for property tax payments made in calendar year 2001 based on the April 1, 2001 assessment.

DO NOT enter information based on property tax assessed prior to April 1, 2001.

Note: Applicants required but failing to file

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

an acceptable EDI report with Department

of Economic and Community Development

within 180 days of filing a claim under the

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

BETR program will forfeit the BETR

reimbursement. EDI reports were mailed by

7. Property Tax Rate ................................ 7

mils

DECD during May 2001 to businesses

required to file the report. The reports were

8. Requested Reimbursement

............... 8

due August 1, 2001.

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.

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. 10/01

Form 800 - Business Equipment Tax Reimbursement Application

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