Foorm Pt-63 - Property Tax Exemption Application
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3PT-63
Property Tax Exemption Application
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
Name of property, equipment or device
City/Township County
Parcel ID
Legal description of real property as shown on tax records
Project Name, Site Description, etc. (optional)
Installation Date
Expected Life
Original Cost
Permit Date
Permit Number
Permit Page Ref.
Standard, rule or guidance that requires the property
Is the primary use to abate and control air, water or land pollution?
Yes
No
If yes, please describe:
Do you use the property, equipment or device for any other purpose?
Yes
No
If yes, please describe:
Note: Attach a general schematic or engineering drawing showing the location of the property, equipment, or device. If you
are applying for more than one property, equipment or device on the same parcel, attach a schedule with the above
information listed for each property, equipment or device.
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. 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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