Looking for a Kentucky Tax Forms And Templates? Download it for free!

51A300 (6-08)

Commonwealth of Kentucky

DEPARTMENT OF REVENUE

APPLICATION FOR PREAPPROVAL

FOR ENERGY EFFICIENCY MACHINERY OR EQUIPMENT

IMPORTANT: Application not valid unless completed in full.

Pursuant to KRS 139.518 and 103 KAR 31:200, this application is to be completed for preapproval for new or

replacement machinery or equipment that reduces the consumption of energy or energy-producing fuels in the

manufacturing process at a plant facility in this state by at least ﬁ fteen percent (15%) measured in megawatts,

gallons, or other measurable units of energy, while maintaining or increasing the number of units of production

for that same period. This preapproval may only be applied for by a person engaged in manufacturing, and must

be made prior to purchasing the new or replacement machinery or equipment, and the purchase date must be on

or after July 1, 2008.

Applicant __________________________________________________________________________________________________

(Manufacturer’s Name)

Location Address ____________________________________________________________________________________________

Mailing Address _____________________________________________________________________________________________

Name of Contact (please print) __________________________

Title _____________________________________________

Telephone Number (with area code) ______________________

Email Address _____________________________________

The following must be completed and documentation attached:

1. Description and use of New or Replacement Machinery/Equipment to be purchased.

_______________________________________________________________________________________________________

2. Date the machinery/equipment will be placed in service. _______________________________________________________

Attach documentation showing the amount of energy or energy-producing fuels consumed in the 12 month period prior to

this application for preapproval.

THE UNDERSIGNED HEREBY CERTIFIES: That the machinery or equipment to be purchased is to be used in their

manufacturing process at their plant facility located in the Commonwealth of Kentucky. The Department reserves the right

to request other information as deemed necessary.

By _________________________________________________________

_______________________________________________

(Signature)

(Title)

Date _______________________________________________________

Form 51a300 - Application For Preapproval For Energy Efficiency Machinery Or Equipment