Biotechnology Products And Medical Devices Application For Sales And Use Tax Deferral 82.75 Rcw Page 2
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1
2
3
4Business Activity to be Conducted at this Facility
Yes
No
If additional space is needed to answer question 1, please
6. Is the medical device recognized in the
national formulary, United States
attach additional pages.
pharmacopoeia, or any supplement to
1. Describe the nature of your manufacturing activity at
them?
this facility:
7. Is the medical device intended for use
in the diagnosis of disease, or in the
cure, mitigation, treatment, or
prevention of disease or other
conditions in human beings or animals?
8. Is the medical device intended to affect
the structure of any function of the
Biotechnology Product
body of human beings or other animals,
which cannot be achieved through
2. Check the product(s) produced through the application
chemical action and which cannot be
of biotechnology used in the prevention, treatment, or
achieved by metabolizing?
cure of diseases or injuries to humans.
9. Are you currently paying manufacturing
Virus ........................................................................
or processor for hire business and
Therapeutic Serum ..................................................
occupation tax on the above described
Antibody .................................................................
activity?
Protein .....................................................................
10. If the answer to question 9 is “No,” is
this a new manufacturing activity for
Toxin .......................................................................
your business?
Antitoxin .................................................................
Vaccine....................................................................
Blood .......................................................................
Lessee/Lessor Information
Blood Component or Derivative .............................
Yes
No
Allergenic Product ..................................................
11. Will the facility housing the operation
Analogous Product ..................................................
be leased by the applicant?
Yes
No
12. Name of individual or entity that is
3. Are you currently paying manufacturing
paying for the construction of the
or processor for hire business and
building or improvements?
occupation tax on the above described
activity?
__________________________________________
4. If the answer to question 3 is "No" is
13. Name of individual or entity that will be
this a new manufacturing activity for
manufacturing at this location?
your business?
__________________________________________
14. Do the lessee and lessor have 100%
Medical Devices at this Facility
same ownership?
5. What type of medical device will be designed or
If yes, please provide documentation to
developed including any component, part, or accessory?
substantiate the relationship.
Check all that apply.
15. If the answer to question 14 is “No,”
Instrument ...............................................................
has the lessor agreed by written contract
Apparatus ................................................................
to pass the economic benefit of the
Implement ...............................................................
deferral on to the lessee by any type of
payment credit or other financial
Machine ...................................................................
arrangement?
Contrivance .............................................................
(Please attach a completed Lessor’s Application and a copy of the lease
Implant ....................................................................
agreement reflecting the economic benefit of the deferred tax is passed
In Vitro Reagent ......................................................
onto the lessee by any type of payment, credit, or other financial
Other Similar or Related Article .............................
arrangement between the lessor and qualified lessee.) If the individual or
entity paying for the construction is different from the manufacturer,
Explain
please contact the department for further instruction.
The lessee that receives the economic benefit must agree in
writing to complete the annual tax incentive survey.
(Attach Copy)
REV 81 1017e (8/19/11)
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