Form 800 - Business Equipment Tax Reimbursement Application

2010

BUSINESS EQUIPMENT TAX

REIMBURSEMENT APPLICATION

Form 800,

page 1

(for eligible personal property taxes paid in 2009)

*1010700*

Application must be ﬁ led no

Check if applicant is a:

Corporation

LLC

....

.........................

later than December 31, 2010.

Partnership

Sole Proprietor

.....

....

If applicant is a corporation, partnership or LLC, enter federal EIN .........................................

Business Name:

If applicant is a sole proprietor, enter social security number ..............................................

First Name:

MI:

Last Name:

Mailing Address:

City/Town:

State:

ZIP Code:

1. Consolidated application (Is property in two or more municipalities?)

YES

(NOTE: If YES, complete lines 2, 4a, 4b, 5, 6, 8 and 9. Lines 5, 6 and 8 must reﬂ ect the total from all municipalities. Do not complete lines 3 and 7. If NO, complete lines 2 through 9.)

2. Business Code:

4a.

Check this box if the business was started on or after April 1, 1995 .......

4b.

Check this box if the business also receives reimbursement for

3. Municipal Code:

(see pages 5 and 6)

personal property taxes under a TIF agreement (see instructions) .........

Enter the following information for property tax payments made in calendar year 2009 based on the April 1, 2008 and/or April 1, 2009 assessments.

See Instructions.

Assessed April 1, 2008

Assessed April 1, 2009

5. Original cost of eligible property .......................... 5a.

5b.

6. Assessed Value ................................................... 6a.

6b.

7. Property Tax Rate ................................................. 7a.

mils

7b.

mils

8. Requested Reimbursement

(see instructions on page 4)8a. ............................ 8a

8b.

(Enter 90% of lines 8a and 8b) .......................... 8c.

8d.

9. Total Reimbursement. Line 8c plus line 8d ...............................................................................................9.

Eligible property only, taking into account any early payment discounts, but exclusive of any interest, penalties or any other charges. Dated proof

of tax payment and a copy of the tax bill must be included with your claim. Requested reimbursement must exclude any portion of the property

tax payments related to property not eligible for the program. Other limitations apply. See instructions on page 4.

To reduce printing and postage costs, if you have your return done by a tax preparer and do not need the Business Equipment Tax

Reimbursement booklet mailed to you next year, check the box at the right.........................................................................................................

Applicant (or business owner) signature: Under penalties of perjury, I declare that I have examined this application and accompanying schedules and

statements and, to the best of my knowledge and belief, they are true, correct and complete. Declaration of preparer (other than applicant) is based

on all the information of which the preparer has any knowledge.

Telephone

Applicant ______________________________________

Date

Number

(or business ofﬁ cer)

Preparer

Preparer_______________________________________

Date

ID Number