FOR DEPARTMENT OF REVENUE
State of Washington
USE ONLY
Department of Revenue
Date Received
Miscellaneous Tax Section
PO Box 448
Date Approved
Olympia, WA 98507-9860
TDC #
Other
HIGH TECHNOLOGY APPLICATION
FOR TAX DEFERRAL
82.63 RCW and WAC 458-20-24003
(Please submit original application and one copy before construction begins
and/or before possession of machinery and equipment is taken within Washington State)
1. Name of business as registered
2. Mailing Address
3. Name of contact person
4. Phone number
(
)
5. Department of Revenue Registration Number
6. Deferral project address
Street
City
County
7. Technology (check boxes that apply)
¨
¨
Advanced Computing
Advanced Materials
¨
¨
Biotechnology
Electronic Devices Technology
¨
Environmental Technology
When answering questions 8-10 please be precise. Feel free to attach extra pages if needed.
8. Nature of pilot scale manufacturing activity
9. Nature of research and development activity
10. Other
Complete applicable questions 11-15 for your project.
11. Date construction/expansion is to begin
12. Date equipment is to be installed
13. Anticipated project completion date
14. Anticipated project costs (excluding cost of land):
$
a) Construction of new structures(s)
$
b) Expansion/renovation of structures
$
c) Machinery & equipment purchase price
$
d) Total lease contract price for machinery and equipment
e) Fair market value of previously owned machinery and
$
equipment that is new to the state of Washington
15. Total (add a through e)
$
REV 81 1013-1 (3-17-99)