Form 1749e-25 - Application For 25 Percent Recovered Material Electrical Energy Exemption For Manufacturing - 2011 Page 2

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MO. TAX I.D. NUMBER

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PAGE 2

8. NAME AND ADDRESS OF ELECTRICAL ENERGY SUPPLIER

SUPPLIER’S NAME

COUNTY

STREET ADDRESS

CITY

STATE ZIP CODE

9. APPLICABLE NUMBERS ASSIGNED BY SUPPLIER (ATTACH ADDITIONAL LIST IF NEEDED)

PERCENTAGE

ACCOUNT NUMBER(S)

DESCRIPTION OF ELECTRICAL USAGE

EXEMPT

TAXABLE

PART B

SECTION 1. TAXABLE EQUIPMENT LISTING — ATTACH YOUR TAXABLE EQUIPMENT LISTING WITH KWH USAGE

(OR EXEMPT EQUIPMENT LISTING, IF APPLICABLE)

List all taxable equipment, special metered or not, which can include all electricity for air conditioners, lights, refrigerators, heaters, other appliances

and machines used in maintenance of living, office, plant, shop and/or warehouse facilities. Compute total kilowatt hours by completing this section

or attach your calculation of total taxable kilowatt hours.

Description of

Days

Weeks

Estimated Hours

Hours Per

Number

Amp

Wattage

KWH

Per