Form 891 - Application For Water Pollution Control Tax Exemption Certificate Page 2
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3TE-EQUIPMENT
891, Page 2
Application for Water Pollution Control Tax Exemption Certificate
Water Pollution Control Equipment Description
PART 4: GENERAL INFORMATION
11. Describe the water pollution control equipment, the operational procedure, how it will minimize or control water pollution, and any function the
equipment serves. Include non-water pollution control uses.
12. Beginning Date of Construction
13. Projected/Completion Date of Construction
PART 5: EQUIPMENT AND COST DETAILS.
For the equipment associated with the water pollution control that is claimed to
be exempt, provide a description, total cost, and the portion of the total cost being claimed as exempt for each of the items listed. If
an item does not exist, indicate "N/A." Provide plans and specifications of the facility as an additional attachment per Section
3702(1). Provide an itemized list of equipment totaling the amount requested in box #7.
Total Cost of 14
14. Describe the water pollution control equipment. (attach additional pages if necessary.
Costs must be separated into appropriate categories in sections 14 thru 16).
Portion Claiming Tax Exempt (Provide itemized list)
15. Describe the ancillary equipment (foundations, enclosures, electrical equipment,
Total Cost of 15
wastewater storage, chemical treatment storage tanks, pumps, piping, instrumentation &
sludge dewatering equipment, etc.)
Portion Claiming Tax Exempt (Provide itemized list)
16. Describe miscellaneous costs (engineering, administrative fees, etc.)
Total Cost of 16
Portion Claiming Tax Exempt (Provide itemized list)
17. Value of recovered product (must provide per Sec. 3702(2))
Total of 14 - 16
$
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