Form 801a - Assessor Notification Property Claimed For 12 Or Fewer Years - 2010

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2010
2010
ASSESSOR NOTIFICATION
PROPERTY CLAIMED FOR 12 OR FEWER YEARS
Form 801A,
page 1
SEE INSTRUCTIONS
Municipal Code:
SECTION 1. Notice of Intent.
(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 wanting 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. 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 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.
R
08/10
EVISED

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