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FORM
Nebraska Employment and Investment Growth Act
775P
Claim for Nebraska Personal Property Exemption
Name
Project Name
Mailing Address
Project Location
County
City
State
Zip Code
Date of Application
Date of Agreement
Nebraska Taxpayer ID Number
Tax Year End in which the levels of $10 million in investment and 100
Tax Years in which levels were not maintained:
full-time equivalent employees were met.
SUMMARY OF SCHEDULE I — Turbine-Powered Aircraft
Net book value of turbine-powered aircraft claimed (enter total from Nebraska Schedule I, line 15) ....... $
00
Department of Revenue Approval Signature
Date
Amount Approved
$
00
SUMMARY OF SCHEDULE II — Computer Systems and Certain Peripheral Components
Net book value of computer systems and certain peripheral components claimed (enter total from
Nebraska Schedule II, line 16) .................................................................................................................. $
00
Department of Revenue Approval Signature
Date
Amount Approved
$
00
SUMMARY OF SCHEDULE III —
Business Equipment used in the Manufacturing or Processing of Agricultural Products
Net book value of business equipment claimed (enter total from Nebraska Schedule III, line 17) ........... $
00
Department of Revenue Approval Signature
Date
Amount Approved
$
00
Under penalties of law, I declare that I have examined this claim and any accompanying schedules, and to the best of my knowledge and belief, it
is correct and complete.
sign
Authorized Signature
Title
Date
here
Please Print Name of Contact Person
Telephone Number
Email Address
FOR DEPARTMENT USE ONLY
Date Received
Date Reviewed
Reviewed by
Mail this original to:
NEBRASKA DEPARTMENT OF REVENUE, PROPERTY ASSESSMENT DIVISION, PO BOX 98919, LINCOLN, NE 68509-8919.
A COPY OF THIS FORM MUST ALSO BE SENT TO EACH COUNTY ASSESSOR WHERE THE PROJECT IS LOCATED.
Form No. 96-307-2011 Rev. 5-2012
Authorized by Neb. Rev. Stat. § 77-4104
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