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Form 1749 - Application For Electrical Energy Direct Pay Authorization And Basic Steelmaking Exemption

MISSOURI DEPARTMENT OF REVENUE

FORM

DIVISION OF TAXATION AND COLLECTION

1749

APPLICATION FOR ELECTRICAL ENERGY

DIRECT PAY AUTHORIZATION AND BASIC

(REV. 12-99)

STEELMAKING EXEMPTION

PART I — GENERAL INFORMATION

This application is to be used for applying for or renewing electrical energy direct pay authorization and the basic steelmaking exemption

pursuant to Section 144.030.2(12) and Section 144.036, RSMo. The authorization, if issued, is valid for one (1) year only.

PLEASE PRINT OR TYPE AND COMPLETE ALL LINES — Do not write in shaded areas.

Mail completed application and direct questions to: MISSOURI DEPARTMENT OF REVENUE, DIVISION OF TAXATION AND COLLEC-

TION, P.O. BOX 840, JEFFERSON CITY, MO 65105-0840 or call (573) 751-2836. (

TDD 1-800-735-2966 or fax (573) 526-1881)

2. MO. TAX ID NUMBER

3. EFFECTIVE DATE

EXPIRATION DATE

4. TYPE OF APPLICATION

CODE

NEW

RENEWAL

5. PRIMARY BUSINESS LOCATION

BUSINESS TRADE NAME

BUSINESS PHONE (AREA CODE & NUMBER)

(

)

—

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

COUNTY

CODE

CITY

CODE

STATE

ZIP CODE

6. OWNER NAME AND ADDRESS

OWNER NAME

STREET OR ROUTE, P.O. BOX NUMBER

COUNTY

CODE

CITY

CODE

STATE

ZIP CODE

7. MAILING ADDRESS

BUSINESS ADDRESS

OWNER ADDRESS

OTHER (GIVE FULL ADDRESS BELOW)

STREET ADDRESS/P.O. BOX

COUNTY

CODE

CITY

CODE

STATE

ZIP CODE

8. ADDRESS WHERE BOOKS AND RECORDS ARE KEPT

BUSINESS ADDRESS

OWNER ADDRESS

OTHER (GIVE FULL ADDRESS BELOW)

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

COUNTY

CODE

CITY

CODE

STATE

ZIP CODE

9. STANDARD INDUSTRIAL CODE

U.S. STANDARD INDUSTRIAL CLASSIFICATION CODE NUMBER

SIC

10. DESCRIPTION OF BUSINESS OPERATION AND PRODUCTS PRODUCED

11. ELECTRICAL ENERGY USE AND PROCESS TIME

PRIMARY

COMPOUNDING

PROCESSING

MANUFACTURING

MINING

SECONDARY

FABRICATING

PROCESSING

MO 860-0919 (12-99)

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

Form 1749 - Application For Electrical Energy Direct Pay Authorization And Basic Steelmaking Exemption

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