Form Pt-64 - Property Tax Statement Of Exemption
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2PT-64
Property Tax Statement of Exemption
for Property Used for Pollution Control
Name of business which occupies or uses the property
Minnesota Tax ID Number
Business Mailing Address
City
State
Zip
Parcel ID
City/Township
County
Property Name, Site Description, etc. (optional)
Legal description of real property as shown on tax records
Name of Property, Equipment or Device
Application Date
Order Date
Original Cost
Cease Date
Note: Only include property, equipment or devices that have received an order granting a property tax exemption. If you
need to list more than twelve items of property, equipment, or devices, attach a spreadsheet with the above information
listed for each property, equipment, or device. If you have more than one parcel with exempt property, you must submit
a separate PT-64.
I declare the real and personal property listed above was constructed or installed after June 1, 1967 and is primarily used for
the abatement and control of air, land or water pollution. If it is no longer totally or primarily used for the abatement and
control of air, land or water pollution, I listed the date (cease date) that the property no longer qualifies. I certify that the
above information is true and correct to the best of my knowledge. I understand that Minnesota Statutes, section 609.41,
states that anyone giving false information in order to avoid or reduce their tax obligations is subject to a fine of up to $3,000
and/or up to one year in prison.
Signature
Title
Date
Name of Contact Person
Email
Phone
Send an electronic copy of this application to sa.property@state.mn.us
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