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04 BUSINESS EQUIPMENT TAX
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2022 REIMBURSEMENT APPLICATION 99
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07Form 800 (page 1) (for eligible personal property taxes paid in 2021)
*1510700*
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Application must be filed no later than January 3, 2023.
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11 If applicant is a corporation, partnership or LLC, enter federal EIN .................................
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14 Business Name:
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16 If applicant is a sole proprietor, enter social security number ..........................................
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19 First Name: MI: Last Name:
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21 Mailing Address:
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23 City/Town: State: ZIP Code:
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25 1. Consolidated Application (Is property located in two or more municipalities?)
26 (If YES, skip lines 3 and 7. Lines 5, 6 and 8 must reflect the total from all municipalities. If NO, complete lines 2-9.) YES NO
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28 2. Business Code: 4. Check this box if the business also receives reimbursement for
29 personal property taxes under a TIF agreement (see instructions) ......
30 3. Municipal Code: (see pages 7 and 8 )
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32 Enter the following information for property tax payments made in calendar year 2021 based on the April 1, 2020 and/or April 1, 2021 assessments.
33 See Instructions. Assessed April 1, 2020 Assessed April 1, 2021
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35 5. Original Cost of Eligible Property...........5a. $ 5b. $
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37 6. Assessed Value ...................................6a. $ 6b. $
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39 7. Property Tax Rate .................................7a. . mills 7b. . mills
40 8. Requested Reimbursement
41 (see instructions) ..................................8a. $ 8b.$
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43 9. Total Reimbursement. Line 8a plus line 8b ................................................................................ 9. $
44 Include taxes paid for eligible property only, taking into account any early payment discounts, but exclusive of any interest, penalties or any other
45 charges. Dated proof of tax payment and a copy of the tax bill must be included with your application. Other limitations apply. See instructions.
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Third Party Designee: Check this box if you want to allow another person to discuss this return with Maine Revenue Services
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51 Designee’s Name Phone # Email
52 Applicant (or business owner) signature: DECLARATION(S) UNDER THE PENALTIES OF PERJURY. I declare that I have examined this return/
53 report/document and (if applicable) accompanying schedules and statements and to the best of my knowledge and belief they are true, correct, and
54 complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
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57 Applicant (or business officer) Signature and date Phone # Email
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59 Preparer
60 Signature Phone # Date
61 MAIL TO: MAINE REVENUE SERVICES
62 P.O. BOX 1064
63 Preparer ID Number AUGUSTA, ME 04332-1064 Revised 6/2022
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6566
