Form 1749 E-25 - Application For 25 Percent Recovered Material Electrical Energy Exemption For Manufacturing
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Missouri Department of Revenue
Application for 25 Percent Recovered Material
Form
Electrical Energy Exemption for Manufacturing
1749 E-25
Note: This is not a refund application. A refund application must be filed by the utility in order to receive a refund for
periods prior to issuance of the direct pay authorization letter.
Complete this application to apply for electrical energy direct pay authorization if your raw materials used in processing contain at least 25
percent recovered material, according to
Section 144.030.2(13),
RSMo. A separate application should be completed for each calendar
year for which you are applying. If approved and authorized, a non-expiring direct pay certificate will be issued. You do not need to
reapply each year. If at any time you no longer qualify for this exemption, it is your responsibility to notify your utility supplier, withdraw
your exemption, and remit the appropriate tax to the state. If you qualify at a later date you can re-apply at that time.
1. Application Year and Identification Numbers
A
pplication Year (Calendar Year Only)
Type of Application
Missouri Tax I.D. Number
Federal Employer I.D. Number
r
r
New
Renewal
2. Applicable Business Location
Business Trade Name
Business Phone
County
(__ __ __) __ __ __ - __ __ __ __
Street Address (Do Not Use P.O. Box or Rural Route)
City
State
Zip Code
3. Owner Name and Address
Business Trade Name
County
Street Address (Do Not Use P.O. Box Or Rural Route)
City
State
Zip Code
4. Mailing Address (Select One)
County
r
r
r
Business Address
Owner Address
Other (Give Full Address Below)
Street Address
City
State
Zip Code
5. Contact Person (Attach Power of Attorney,
Form 2827
if not employed by applicant).
Name
Title
Phone
(__ __ __) __ __ __ - __ __ __ __
6. Type of Exempt Electrical Energy Usage (Select One)
Note: You must submit an application for each process if you are claiming an exemption for more than one process.
r
r
r
r
r
Primary:
Compounding
Processing
Manufacturing
Mining
Producing
r
r
Secondary:
Fabricating
Processing
r
Material Recovery Processing Plant
7. Description of Business Operations and Products Produced (Attach additional sheet if needed)
8. Name and Address of Electrical Energy Supplier
Supplier’s Name
County
Street Address
City
State
Zip Code
9. Applicable Numbers Assigned by Supplier (Attach additional sheet if needed)
Account Number(s)
Percentage Taxable
Percentage Exempt
Description of Electrical Usage
Form-1749E-25 (Revised 11-2013)
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