Form Pt-63 - Property Tax Exemption Application
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2PT-63
Property Tax Exemption Application
for Property Used for Pollution Control
Name of business which occupies or uses the property
Minnesota Tax ID number
Date of application
Name(s) of property owner(s)
Mailing address
City
State
Zip code
Check box and fill in name of city or township where property is located
County
City
Township
Legal description of the real property as shown on tax records
Parcel ID
Purpose of your business
Pollution Control equipment or devices for which the tax exemption is requested
(attach an additional sheet if necessary)
Name of equipment or device
Pollution control agency permit number
Date permit issued
Is the equipment or device used for the abatement and control of air, water or land pollution?
Yes
No If yes, please describe:
Is the personal property used for any other purpose?
Yes
No What other purpose?
What specific standard, rule or guideline is the property required by?
Specific location within the permit
Name of equipment or device
Pollution control agency permit number
Date permit issued
Is the equipment or device used for the abatement and control of air, water or land pollution?
Yes
No If yes, please describe:
Is the personal property used for any other purpose?
Yes
No What other purpose?
What specific standard, rule or guideline is the property required by?
Specific location within the permit
I declare the real and personal property listed above was constructed or installed after June 1, 1967 and is totally or
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 giv-
ing false information in order to avoid or reduce their tax obligations is subject to a fine of up to $3,000 and/or up one
year in prison.
Signature
Title
Date
Name of Contact Person
Email Address
Phone
Mail to Minnesota Revenue, Mail Station 3340, St. Paul, MN 55146-3340
or send an electronic version to sa.property@state.mn.us
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