Form 7ag-1 - Nebraska Sales And Use Tax Refund Claim printable pdf download

Nebraska Sales and Use Tax Refund Claim

FORM

for Agricultural Machinery and Equipment Purchases or Leases

7AG-1

dep

• Read instructions on reverse side

• Type or print clearly

nebraska

PLEASE DO NOT WRITE IN THIS SPACE

department

of revenue

NAME AND MAILING ADDRESS OF PURCHASER/LESSEE

NAME AND MAILING ADDRESS OF SELLER/LESSOR

Name

Street or Other Mailing Address

City

State

Zip Code

City

State

Zip Code

Property will be Located for Property Taxation

Federal Employer I.D. or Social Security Number

County Where

(a copy of this

claim will be forwarded to the

appropriate county assessor

and all property listed herein

If leased, will this property be leased or rented for less than one year?

will be subject to personal

YES

property taxation)

To qualify for a sales tax refund, all property listed on this claim must be:

Purchased or leased on or after January 1, 1993; and

Agricultural machinery or equipment used in commercial agriculture.

By completing this claim, the purchaser or lessee declares that all property listed herein meets both of

the above conditions.

QUALIFYING MACHINERY AND EQUIPMENT

Date

Description of Property

Nebraska Sales

City

City Sales and Use

Net Purchase/Lease

Purchased/

(List Each Item Separately)

and Use Tax Paid

Imposing Tax

Tax Paid

Price

Leased

Mo. Day Yr.

8 Total city sales and use tax paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 Total Nebraska sales and use tax paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 Total refund claimed for Nebraska and city sales and use tax paid (total of lines 8 and 9). No refund will

be made if the total amount claimed is less than $2.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

I declare, under penalties of law, that I have examined this claim, and to the best of my knowledge and belief, it is correct and complete. I

also declare that payment of this claim has not been previously made by the state, nor have I claimed or received a refund from the retailer.

sign

here

(

)

Signature of Purchaser, Lessee, or Agent

Printed Name

Telephone Number

Date

Mail this claim and supporting documentation to: NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 94818, LINCOLN, NE 68509-4818

IF PROPER DOCUMENTATION IS NOT INCLUDED, YOUR CLAIM CANNOT BE PROCESSED.

NEBRASKA DEPARTMENT OF REVENUE — White Copy

TAXPAYER — Retain canary copy for your income tax records

6-343-93 Rev. 12-95

Form 7ag-1 - Nebraska Sales And Use Tax Refund Claim

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