Form Deq 50-11s Recycling Machinery And Equipment Certification printable pdf download

Form Deq 50-11s Recycling Machinery And Equipment Certification

FORM DEQ 50-11S

RECYCLING MACHINERY AND EQUIPMENT CERTIFICATION

Pursuant to Application for State Income Tax Credit

(Refer to the Form Instructions and Guidance for the Certification of Recycling Machinery and Equipment)

Part I

Name(s) as shown on Virginia Tax return:

Phone number:

Tax ID :

Status: _____ “C” Corporation _____ Individual ____ “Pass-through” Corporation

Street:

City, State, and Zip Code:

Part II

Name of manufacturing facilities or plant units where machinery and equipment will be located (see

Instructions):

Street:

City, State, and ZIP code :

Detailed description of machinery and equipment and its intended use. Attach: a list of equipment to be

certified; process information; proof of purchase, and drawings & brochures as appropriate.

I certify that the above information is true, correct and complete and that the machinery and equipment identified is to be used

primarily for the processing of recyclable materials as defined in either § 58.1-439.7 or § 58.1-439.8 of the Code of Virginia.

_______________________________________________________________ ___________________ ___________________________

Signature of taxpayer /Title

[Please print or type name of taxpayer signing]

Date

[Agency Use Only]

The Department of Environmental Quality’s certification of machinery and equipment, based on the information provided by

the applicant, is contained on the attached Equipment List referencing Application Number _________.

Revised July 20, 2007 Guidance 09-2002

Form Deq 50-11s Recycling Machinery And Equipment Certification