Form 801 - Assessor Notification
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1
2801
ASSESSOR NOTIFICATION
SECTION 1. Notice of Intent.
1A. MUNICIPALITY OF __________________________ Dear Assessor: Pursuant to 36 MRSA, §6653, you are hereby
notified that ________________________________________________ * intends to file a claim with the Executive
Director of Maine Revenue Services for reimbursement of property tax associated with “qualified business property” first
placed in service in Maine after April 1, 1995.
*Claimant name
1B. Claimant is a:
C-Corporation __
S-Corporation _
Partnership __
Sole Proprietor __
SECTION 2. Schedule for Business Equipment Tax Reimbursement.
The “qualified business property” is situated at (street address, map & lot, account#, etc.):
_______________________________________________________________________________________________
Valuation components determined by the local tax assessors establish an essential basis for taxpayers wishing to partici-
pate in this program. I am requesting that you provide information pertaining to the assessor’s value for “qualified busi-
ness property” in Column F and relevant assessment information in Section 3 on the reverse side. Please enter the
necessary information and return this schedule to me within 60 days or make this information available to me when the tax
bills are issued, whichever occurs later. I believe the following listed property constitutes “qualified business property”
which is eligible for reimbursement by the State of Maine.
A.
B.
C.
D.
E.
F.
Assessor’s
Property
State of Origin
No. of Years
Date Placed
Original
Value (to be completed
Description
if acquired used
Claimed
in Service
Cost
by local tax assessor)
/
/
1. __________________________
____________
______
________
$ _________ $ ____________
2. __________________________
____________
______
________
__________
_____________
3. __________________________
____________
______
________
__________
_____________
4. __________________________
____________
______
________
__________
_____________
5. __________________________
____________
______
________
__________
_____________
6. __________________________
____________
______
________
__________
_____________
7. __________________________
____________
______
________
__________
_____________
8. __________________________
____________
______
________
__________
_____________
9. __________________________
____________
______
________
__________
_____________
10. __________________________
____________
______
________
__________
_____________
11. __________________________
____________
______
________
__________
_____________
12. __________________________
____________
______
________
__________
_____________
13. __________________________
____________
______
________
__________
_____________
14. __________________________
____________
______
________
__________
_____________
15. __________________________
____________
______
________
__________
_____________
Rev. 3/98
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