Form Ppt Ecf - Application For Energy And Solid Waste Energy Conversion And Thermal Efficiency Improvement Facility
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PPT ECF
Rev. 9/05
P.O. Box 530
Columbus, OH 43216-0530
Application for Energy and Solid Waste Energy Conversion
and Thermal Efficiency Improvement Facility
1.a. Type of facility (check one):
Energy
Solid waste
Thermal efficiency
1.b. Number of substantially similar facilities in county
Owner of Facility Information*
2. Type of ownership:
Individual
Partnership
Corporation
LLC
LP
LLP
Joint
Other
3. Owner(s) name
4. Mailing address
Street
City
State
ZIP code
5.a. Federal employer identification no. (FEIN)
5.b. Ohio charter or license no.
Facility Information
6. Facility name
7. Physical address
Street
City
State
ZIP code
8.
Taxing district
Township
School district
Ohio county
9.a. Facility cost (total) $
9.b. Cost sought for exemption $
9.c. Cost is
Actual
Estimated
10.a. Facility is
Completed
Being constructed
Planning stage
10.b. Date facility completed or estimated date (month/year)
10.c. Facility information (see instructions)
11. Include the following documents and/or information as attachments:
a. Copy of the plans, specifications and drawings detailing the facility for which a certificate is requested (label as “Attachment A”).
b. Complete the Exempt Facility Property Listing labeled as “Attachment B.”
c. Narrative statement that succinctly explains all the purposes and operations of the facility (label as “Attachment C”).
12. Fee amount. If line 9.a. is greater than $400,000 enter $2,000, otherwise multiply line 9.a. by 0.005 $
Primary Contact Person Information**
13. Contact person name
E-mail address
14. Mailing address
Street
City
State
ZIP code
15. Telephone number
Fax number
Other (describe)
Tax Exemption Status
Unless notified by the tax commissioner to the contrary, the applicant is allowed to claim property sought for exemption on line 9.b. as
exempt from certain taxes pursuant to Ohio Revised Code 5709.25. Please note that any exemption claimed is subject to assessment
(even beyond the normal time period for an assessment to be issued) if it is subsequently ascertained the applicant was not entitled
to the exemption.
16. Does applicant intend to claim the property on line 9.b. as exempt prior to the certificate being issued?
Yes
No
Signature
I declare under penalties of perjury that this application (including any accompanying documentation) has been examined by me and
to the best of my knowledge and belief is a true, correct and complete application.
17.
Authorized signature
Date
18.
Name and title
Phone number
* This is the contact location where the issuance, or denial, of a certificate will be mailed.
** This is the contact location where additional information will be requested.
In order to expedite the processing of your application, please submit in triplicate the application and
all accompanying documentation (along with applicable fee) to: Office of Chief Counsel,
Tax Appeals Division, P.O. Box 530, Columbus, OH 43216-0530. Phone: (614) 466-6750.
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