Form 51a228 - Tax Exemption Certificate - Application Form For Fluidized Bed Combustion Technology
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151A228 (5-07)
FOR OFFICIAL USE ONLY
Commonwealth of Kentucky
APPLICATION
DEPARTMENT OF REVENUE
FOR
FLUIDIZED BED COMBUSTION TECHNOLOGY
TAX EXEMPTION CERTIFICATE
Name of
(
)
Business
Enter exact name of business, governmental unit or institution (please print or type)
Telephone Number (include area code)
Location of
Facility
Number and Street
City or Town
County
State
ZIP Code
Mailing
Address
P.O. Box or Number and Street
City or Town
County
State
ZIP Code
Nature of
Business
1.
Plans must be submitted to the Department of Revenue with this application. Should the plans not be available at this time,
indicate the approximate date the plans will be submitted. __________________________________________________
2.
A listing of equipment and materials for the facility must be included with this application. Should the listing not be available
at this time, indicate the approximate date the listing will be available. ________________________________________
3.
Is the facility for which this application is made presently in existence?
Yes
No
4.
Estimated or actual capitalized cost of construction (as determined by the IRS) of the facility. _____________________
5.
Estimated market value of the facility for which application is made. _________________________________________
6.
Expected completion date. ___________________________________________________________________________
The above statements are hereby certified to be correct to the best knowledge and belief of the undersigned who is duly authorized
to sign this application.
Person Authorized to Sign ___________________________________________________________
(Please print)
Signature
________________________________________________________________________
Title
____________________________________________
Date _______________________
Return completed application to Department of Revenue,
Frankfort, Kentucky 40620.
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