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Form 1749e-10 Draft - Application For 10 Percent Electrical Energy Exemption For Manufacturing - 2008

MISSOURI DEPARTMENT OF REVENUE

TAXATION BUREAU

FORM

1749E-10

APPLICATION FOR 10 PERCENT ELECTRICAL ENERGY

EXEMPTION FOR MANUFACTURING

(REV. 09-2008)

NOTE: THIS IS NOT A REFUND APPLICATION. A REFUND APPLICATION MUST BE FILED BY THE UTILITY IN ORDER TO RECEIVE A REFUND FOR

PERIODS PRIOR TO ISSUANCE OF THE DIRECT PAY AUTHORIZATION LETTER

PART A — GENERAL INFORMATION

Complete this application to apply for electrical energy direct pay authorization if your electrical energy costs exceed 10 percent of total

production cost pursuant to Section 144.030.2(12), RSMo. This application should be completed for one calendar year. If approved and

authorized, the exemption will be issued. If at any time you no longer qualify for this exemption, it is your responsibility to notify your utility

supplier, withdraw your exemption, and remit the appropriate tax to the state.

Mail completed application and direct questions to: MISSOURI DEPARTMENT OF REVENUE, TAXATION BUREAU, P.O. BOX 358,

JEFFERSON CITY, MO 65105-0358 or call (573) 751-2836. (

TDD 1-800-735-2966 or fax (573) 751-9409)

1. APPLICATION YEAR / ID NUMBERS

APPLICATION YEAR (CALENDAR YEAR ONLY)

TYPE OF APPLICATION

NEW

RENEWAL

MO. TAX ID NUMBER

FEIN

2. APPLICABLE BUSINESS LOCATION

BUSINESS TRADE NAME

BUSINESS PHONE (AREA CODE & NUMBER)

(

)

—

STREET ADDRESS (DO NOT USE P.O. BOX OR RURAL ROUTE)

COUNTY

CITY

STATE ZIP CODE

3. OWNER NAME AND ADDRESS

OWNER NAME

STREET OR ROUTE, P.O. BOX NUMBER

COUNTY

CITY

STATE ZIP CODE

4. MAILING ADDRESS (Check one)

BUSINESS ADDRESS

OWNER ADDRESS

OTHER (GIVE FULL ADDRESS BELOW)

STREET ADDRESS/P.O. BOX NUMBER

COUNTY

CITY

STATE ZIP CODE

5. CONTACT PERSON

(Attach Power of Attorney if not employed by applicant. Form 2827 can be obtained at )

NAME

TITLE

PHONE

(

)

—

6. TYPE OF EXEMPT ELECTRICAL ENERGY USAGE (Check one)

NOTE: You must submit an application for each process if you are claiming an exemption for more than one process.

PRIMARY:

COMPOUNDING

PROCESSING

MANUFACTURING

MINING

PRODUCING

SECONDARY:

FABRICATING

PROCESSING

MATERIAL RECOVERY PROCESSING PLANT

7. DESCRIPTION OF BUSINESS OPERATIONS AND PRODUCTS PRODUCED (attach additional sheet if needed)

MO 860-0919 (09-2008)

This publication is available upon request in alternative accessible format(s).

Form 1749e-10 Draft - Application For 10 Percent Electrical Energy Exemption For Manufacturing - 2008

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