Form Cab-4 - Value-Added Manufacturing Machinery Certification Application

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MONTANA
CAB-4
Rev. 03-08
Value-added Manufacturing Machinery
Certifi cation Application
Please complete and send this application to the Montana Department of Revenue, Business Tax and
Valuation Bureau, PO Box 7149, Helena, MT 59604-7149.
1. Name of Applicant ___________________________________________________________________
2. Applicant’s FEIN ____________________________________________________________________
3. Address of Applicant’s Principal Place of Business __________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
4. Legal Description of Plant Location ______________________________________________________
____________________________________________________________________________________
5. Please attach a description of all machinery and equipment at the plant location that may qualify as value-
added machinery. Include the original installed cost and the date of installation.
6. Explanation of the value-added process __________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
7. What raw material or semi-fi nished product is used? ________________________________________
8. Where is the raw material or semi-fi nished product obtained? _________________________________
____________________________________________________________________________________
9. What product is produced? ____________________________________________________________
10. Please list each employee of the original manufacturing plant, including position number name,
identifi cation number, annual hours worked and the annual wage or salary earned.
Position No.
Name
ID No.
Hours
Annual Wage
Attach Additional Sheets if Necessary
454
Original - Montana Department of Revenue, Helena, Montana
Copies - Local Department of Revenue County Assessment Offi ce and Applicant

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