ASSESSOR NOTIFICATION
2016
PROPERTY CLAIMED FOR 12 OR FEWER YEARS
Form 801A
(page 1)
SEE INSTRUCTIONS
Municipal Code: _______
(see pages 12 and 13)
SECTION 1. Notice of Intent.
1. MUNICIPALITY OF _____________________________________________________________________________
Dear Assessor: Pursuant to 36 M.R.S. § 6653, you are hereby notifi ed that :
(applicant name)
intends to fi le an application with Maine Revenue Services for reimbursement of property tax associated with eligible
business property fi rst placed in service in Maine after April 1, 1995 for taxes assessed April 1, ____________.
SECTION 2. Schedule for Business Equipment Tax Reimbursement. (
Attach additional sheets if needed)
The eligible business property is situated at (street address, map & lot, account #, etc.):
________________________________________________________________________________________________
Valuation components determined by the local tax assessor establishes an essential basis for taxpayers wanting to participate
in this program. I am requesting that you provide information pertaining to the assessed value for eligible business property
in column F and relevant assessment information in Section 3. Please enter the necessary information sorted by “Number
of Years Claimed” and return this schedule to me within 60 days or make this information available to me when the tax
bills are issued, whichever occurs later. I believe the following property constitutes business property which is eligible for
reimbursement by the State of Maine.
A.
B.
C.*
D.
E.
F.
Property Description
State of Origin
Number
Date Placed in
Original
Assessed Value
(if acquired
of Years
Service
Cost
(To be completed by
used)
Claimed
(month/year)
local tax assessor.)
1. __________________________
_______
______
__________
$ _____________
$ _____________
2. ___________________________
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__________
______________
______________
3. ___________________________
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______________
______________
4. ___________________________
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5. ___________________________
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______________
6. ___________________________
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__________
______________
______________
7. ___________________________
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______________
8. ___________________________
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__________
______________
______________
9. ___________________________
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__________
______________
______________
10. __________________________
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______________
11. __________________________
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12. __________________________
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______________
13. __________________________
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14. __________________________
_______
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______________
______________
15. __________________________
_______
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__________
______________
______________
* Form 801A is for property claimed 12 or fewer years. See instructions.