Intangible Personal Property Exemption Application Form - Wyoming Department Of Revenue
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7State of Wyoming
Intangible Personal Property Exemption Application Form
PART 1 – Tax Payer Identification
1. Company Name/Applicant:
2. Representative:
(Name / Title)
3. Address:
4. City, State:
5. Zip Code:
6. Email Address:
7. Phone:
8. Fax:
PART 2 – Property / Plant Information
Plant / Property Location:
10. Business Operations Conducted:
9.
(Address / Legal Description)
11. County:
12. Tax District:
PART 3 – Certification
13. The forgoing information is submitted in accordance with the provisions of Section 39-11-105, (a), (xxix), and the Wyoming Dept. of Revenue
Rules & Regulations Chapter 14, Sec. 10. The information provided herein and any estimate of market value complies with generally accepted
appraisal standards and generally accepted accounting principles for the treatment and valuation of intangible assets, and is true and correct to the
best of my knowledge, and believed under penalty of perjury.
Signature:
Title:
Date:
*Duplicate The Following Page As Needed. Each Item Requested For Exemption Must Be Individually Itemized.*
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