Form 1749e-25 - Application For 25 Percent Recovered Material Electrical Energy Exemption For Manufacturing - 2011

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FORM
MISSOURI DEPARTMENT OF REVENUE
TAXATION DIVISION
1749E-25
APPLICATION FOR 25 PERCENT RECOVERED MATERIAL
ELECTRICAL ENERGY EXEMPTION FOR MANUFACTURING
(REV. 09-2011)
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 raw materials used in processing contain at least
25 percent recovered material, 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 DIVISION, 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)
DOR-1749E-25 (09-2011)
This publication is available upon request in alternative accessible format(s).

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