Form 54-064 - Combined Request For Pollution Control And Recycling Property Tax Exemption And Certification Of Pollution Control And Recycling Property
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Combined Request for Pollution Control and Recycling Property Tax Exemption
and Certification of Pollution Control and Recycling Property
IMPORTANT: The application should be filed with the Department of Natural
Resources (DNR) by January 1, so there will be sufficient time for the DNR to
process the request and mail a certification (if approved) to you and for you to
APPLICATION FOR EXEMPTION
provide a copy of the application and the DNR certification to your assessing
authority by the February 1, filing deadline. Please read the instructions carefully.
TO:
Assessing Authority
Application is hereby made for exemption from property tax of the pollution control or recycling property described
herein. The information in this application is, to the best of my knowledge and belief, true and correct.
REQUEST FOR CERTIFICATION OF POLLUTION CONTROL OR RECYCLING PROPERTY
TO:
Iowa Department of Natural Resources, Wallace Building, Des Moines IA 50319
Request is hereby made for certification of the property described herein. The information in this request is submitted in
accordance with the provisions of 427.1(19) of the Code of Iowa, and the rules of the Iowa Department of Natural
Resources, and to the best of my knowledge and belief is true and correct.
Construction of the property for which certification is requested was completed on ________________ , ________ ,
and the property has been in continuous use, periods of breakdown, repair, or plant shutdown excepted,
since ________________ , ________ .
Print Name: ______________________________________ Signature: ____________________________________
Title: ___________________________________________ Date: ________________________________________
Type of Property (check one):
Name of Taxpayer: _______________________________
Agricultural wastewater disposal system
Address: _______________________________________
Department construction permit no.: ___________________
City-State-Zip Code: _____________________________
Department operation permit no.: ______________________
Phone No.: _____________________________________
Industrial wastewater disposal system
Check One:
Corporation
Partnership
Individual
Location of Property
Department construction permit no.: ____________________
Street Address: __________________________________
Department operation permit no.: ______________________
City: __________________________________________
Domestic wastewater disposal system
County: ________________________________________
Department construction permit no.: ___________________
Legal description of land on which property is located:
Department operation permit no.: ______________________
______________________________________________
Pretreatment facility
of Section __________ ,Township __________ North,
Air pollution control equipment
Range _____________
Department permit no.: _____________________________
or _____________________________________________
Recycling property
To obtain additional information about this request:
Other (specify): _______________________________
Name: ______________________________________________
If no department permit has been issued, explain:
Address: ____________________________________________
______________________________________________
City-State-Zip Code: __________________________________
______________________________________________
Phone No.: __________________________________________
Address to which certificate should be sent if not to
taxpayer’s address.
DEPARTMENT OF NATURAL RESOURCES USE ONLY
Certificates cannot be sent to your assessor or to the Iowa
Request No. __________________________________
Department of Revenue.
Received ____________________________________
Name: ______________________________________________
Certification granted on _________________________
Address: ____________________________________________
Certification denied on __________________________
City-State-Zip Code: __________________________________
Phone No.: __________________________________________
54-064a (3/11/08)
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