Form 800 - Business Equipment Tax Reimbursement Application - 2000
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1
2BUSINESS EQUIPMENT TAX
REIMBURSEMENT
800
APPLICATION
Form
001071000
Month
Day
Year
Check if applicant is a:
Corporation
Partnership
Application
-
-
Sole Proprietor
LLC
date:
-
If applicant is a corporation, partnership or LLC, enter federal ID number ...............
Business Name
-
-
If applicant is a sole proprietor, enter Social Security number ..................................
Your First Name
Initial
Your Last Name
Mailing Address
Town/City
State
ZIP
1. Consolidated application?
YES
(If yes, complete lines 2, 5, 6 and 8, which must reflect the total
from all municipalities. Do not complete lines 3, 4, 7, 9 and 10.)
NO
(If no, complete lines 2 through 10.)
2. Business Code
3. Municipal Code
4. Check this box if business was started on or after April 1, 1995
$
,
,
5. Original cost of eligible property ....... 5
.
$
,
,
6. Assessed value ................................. 6
.
.
7. Property tax rate ................................ 7
mils
-
$
,
,
8. Requested reimbursement ................ 8
.
-
-
9. Payment date .................................... 9
Month
Day
Year
10. Payment number ............................. 10
of
-
Tax paid on eligible property only, taking into account any early payment discounts, but exclusive of any interest, penalties
or any other charges. Proof of tax payment and a copy of the tax bill must be included with your claim. If making
installment payments, see instructions for line 8 on page 4. Requested reimbursement must exclude any portion of the
property tax payments related to property not eligible for the program.
Applicant (or business owner) signature: Under penalties of perjury, I declare that I have examined this application and
accompanying schedules and statements and, to the best of my knowledge and belief, they are true, correct and complete.
Declaration of preparer (other than applicant) is based on all the information of which the preparer has any knowledge.
Telephone
-
-
-
-
Applicant ____________________________ Date
number
(or business officer)
Preparer
-
-
Preparer ____________________________ Date
ID number
-
-
Preparer telephone number
office use only
Rev. 5/00
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Parent category: Financial