Form 51a216 - Application For Pollution Control Tax Exemption Certificate
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251A216 (7-13)
APPLICATION
FOR OFFICIAL USE ONLY
Commonwealth of Kentucky
FOR
DEPARTMENT OF REVENUE
POLLUTION CONTROL
TAX EXEMPTION CERTIFICATE
Name of
Business
(
)
Enter Exact Name of Business, Governmental Unit or Institution (please print or type)
Telephone Number (include area code)
Location of
Facility
Number and Street
City or Town
County
State
ZIP Code
Mailing
Address
P.O. Box or Number and Street
City or Town
County
State
ZIP Code
1. Check categories for which application is being made.
(a)
AIR: Any property designed, constructed or installed as a component part of any commercial or industrial premises
for the primary purpose of eliminating or reducing the emission of, or ground level concentration of, particulate
matter, dust, fumes, gas, mist, smoke, vapor, or odorous substances, or any combination thereof which renders air
harmful or inimical to the health of persons or to property within this commonwealth:
(b)
WATER: Any disposal system or any treatment works, pretreatment works, appliance, equipment, machinery,
or installation constructed, used, or placed in operation primarily for the purpose of reducing, controlling, or
eliminating thermal pollution or water pollution caused by industrial waste, or what would be industrial waste, if
discharged into the waters of the commonwealth;
(c)
WASTE: Any disposal system or any appliance, equipment, machinery, or installation constructed, used, or placed
in operation primarily for disposing of waste, converting waste into an item of real economic value, or converting
hazardous waste to nonhazardous waste;
(d)
NOISE: Any property designed, constructed, or installed as a component part of any commercial or industrial
premises for the primary purpose of eliminating or reducing the emission of sound which is harmful or inimical to
the health of persons or to property, or materially reduces the quality of the environment in this commonwealth;
(e)
SUBSTANCE REMOVAL: Any property designed, constructed, or installed for the primary purpose of removing
substances from raw materials, which substance, if permitted to become a component part of the finished product,
would have a deleterious effect on the environment when the finished product was utilized.
2. Nature of Business_________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
3. Project Name and/or Number _________________________________________________________
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Parent category: Financial