Five-Year Ad Valorem Tax Exemption For Manufacturers File Checklist Form

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2011
County Check List
FIVE-YEAR AD VALOREM TAX EXEMPTION
FOR MANUFACTURERS
FILE CHECKLIST
APPLICANT
COUNTY
SCHOOL DIST.
XM#
YEAR
PLEASE CHECK THE APPROPRIATE SPACE BELOW WHEN COMPLETED
Signed 900 XMA-B form showing approval or disapproval for each application. Signed
by both Assessor and CBOE. If stamped must be initialed.
One completed application for each year's assets claimed for exemption
Company Federal ID #
Contact Information
Insurance Carrier
Applicable NAICS Code(s)
Qualifying category Question 6A, 6B, 6C 6D and Form 900XM-R1/10
Amount claimed for exemption (Question 7) land, building, machinery and equipment,
or leasehold improvements
Asset list. (Eligible year only per asset list NO MULTIPLE YEAR ASSET LISTS)
Signature of applicant with current notary (page 4). BT129 completed by Tax Rep.
Oklahoma Power of Attorney form completed by Tax Rep if applicable (BT129)
Assessment percentages, Ad Valorem Ref #, Assessor’s Signature and date (Page 4)
Correct information on EMPLOYMENT LEVEL AFFIDAVIT (Pg. 5)
Enclose copy of field data card and warranty deed or lease/purchase agreement for
claims relating to real property
Copy of county worksheet showing calculation of valuation and depreciation amounts
for business personal property
Affidavit - (three year or less expansion plan)
Copy of completed checklist for each application
Is this company in protest or litigation with the county concerning these assets value?
Yes No
Completed by ___________
Date_________

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