Form Otc 900xm - Application For Five-Year Ad Valorem Tax Exemption For Oklahoma Manufacturing Or Research & Development Facilities Page 3

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Revised Jan 2013
OTC FORM 900XM-R01/13
APPLICATION FOR FIVE-YEAR
AD VALOREM TAX EXEMPTION FOR
OKLAHOMA MANUFACTURING
OR RESEARCH & DEVELOPMENT FACILITIES
INCOMPLETE APPLICATIONS WILL BE NULL AND VOID
(
)
SEE ENCLOSED INSTRUCTIONS
To County Assessor of
_ _______ County
FOR ASSESSOR USE ONLY
Year Company was Established in Oklahoma ______ ______________
Application XM#
Millage
Year This Facility became Operational in Oklahoma ___ _____________
Date Filed
Sch. Dist.
Year Assets Acquired
Federal ID#
_______ ___________
Real Acct #
Pers Acct #
Manufacturers Sales Tax Exemption Permit # _____ __________
Application is hereby made for ad valorem tax exemption on an exempt manufacturing facility or research and development
facility located in the above county on January 1,
, in accordance with the provisions of 68 O.S., Section 2902, as
amended.
APPLICANT NAME:
MAILING ADDRESS:
CORPORATE CONTACT NAME, TELEPHONE AND E-MAIL ADDRESS: ______________________________________________
FACILITY CONTACT NAME AND TELEPHONE:
FACILITY PHYSICAL LOCATION:
EMPLOYEE BASIC HEALTH INSURANCE CARRIER:
INSURANCE CARRIER MAILING ADDRESS:
POLICY NUMBER:
APPLICABLE NAICS CODE(S) AND MATERIALS USED:
MANUFACTURING ACTIVITY DESCRIPTION:
2.
Is the facility a research and development facility as defined in Title 68 O.S. 2011 Supp. §2902 as amended?
YES
NO
If yes, explain the activity: R
EXPLANATION: _________________________ ___________________________________________________
3.
Is this the Initial Year of the application? YES___ NO___
4.
Has the applicant continued to operate all facilities in Oklahoma? YES
NO
If no, explain the circumstances
involved. EXPLANATION:
____________________________________________
5. Is this Personal Property Only? YES____ NO _____ If No, continue. If Yes, please skip to Question 7
-1-

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