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Michigan Department of Treasury TE-SOURCE
3828 (Rev. 12-20)
Application for Air Pollution Control Tax Exemption Certificate
Issued under authority of P.A. 451 of 1994, as amended, Part 59. Filing is mandatory.
General Information. Complete All Boxes.
New Amend Transfer Certificate #1
PART 1 SOURCE IDENTIFICATION. This section pertains to the facility where the air pollution control equipment is located.
1. Company Name (Applicant must be owner of facility) 2.AQD Source ID (SRN)

Address (equipment location) 3.Primary SIC Code

City, State, ZIP Code 4. County

 5. Name of Taxing Authority. Select one only. City of
Township of
Village of
6.Describe the major process or processes of the pollution control equipment at the facility.

7. Enter the total value of requested tax exemption. Indicate whether value is "Estimated" or "Final" by checking the appropriate box.
(If cost is estimated, you must supply the final cost within 90 days of completion of construction.) May apply with estimated costs only if project is
not completed. Estimated Final
$

PART 2: TECHNICAL CONTACT/PREPARER. Technical contact should be able to respond to technical questions
concerning this application. Enter Preparer information, if different than Technical Contact.
8.Technical Contact Name Position/Title

E-mail Address Telephone Number Fax Number

9.Preparer Name Position/Title

Company Name Telephone Number Fax Number

Company Mailing Address E-Mail Address

PART 3: COMPANY REPRESENTATIVE. COMPANY REPRESENTATIVE INFORMATION. Name and address for Tax Exemption ResponseName and address for Tax Exemption response. Complete all boxes.
10. Company Official Name Position/Title

Street Address City, State, ZIP Code

E-mail Address Telephone Number Fax Number

I certify that all the information contained in this tax exemption application is true and correct to the best of my knowledge.
Signature of Company Official (No authorized agents) Date

FOR OFFICE USE ONLYFOR STATE USE ONLY
Application Number Reviewed By Date Received/Date Reviewed LUCI Code

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3828, Page 2 TE-EQUIPMENT

Application for Air Pollution Control Tax Exemption Certificate
Air Pollution Control Equipment Description. May attach multiple TE-Equipment pages to one TE-Source.
PART 4: GENERAL INFORMATION
13. AQD Source ID (SRN) 14. Emission Unit

15. Describe the air pollution control equipment, the operational procedure, how it will minimize or control air pollution, and any function the equipment
serves that is other than for ambient air pollution control. Include non-air pollution control uses.

16. Permit Number/Permit Exemption Rule (must 17. Beginning Date of Construction 18. Projected/Completion Date of Construction
be provided)

PART 5: EQUIPMENT AND COST DETAILS. For the equipment associated with the air pollution control that is claimed to be
exempt, provide a description, total cost, and the portion of the total cost being claimed as exempt for each of the items listed. If an
item does not exist, indicate "N/A." Provide plans and specifications for the facility, as an additional attachment, per Section 5902
(1). Provide an itemized list of equipment totaling the amount requested in box #7.
19. Describe the air pollution control equipment (attach additional pages if necessary. Total Cost of 19
Costs must be separated into appropriate categories in 20-24). $
Portion Claiming Tax Exempt (provide itemized list)
$

20. Describe the stack and specify other process/processes equipment associated with Total Cost of 20
this stack. $
Portion Claiming Tax Exempt (provide itemized list)
$
21. Describe the ancillary equipment (foundations, enclosures, electrical equipment, etc.). Total Cost of 21
$
Portion Claiming Tax Exempt (provide itemized list)
$
22. Describe the fans and motors. Distinguish between static pressure needed for the Total Cost of 22
plant's HVAC and process applications, and that needed for air pollution control
equipment. $
Portion Claiming Tax Exempt (provide itemized list)
$
23. Describe the ductwork and hoods including the percentage of ductwork necessary for Total Cost of 23
air pollution control purposes. (Do not include the percentage which is for the benefit of
personnel). $
Portion Claiming Tax Exempt (provide itemized list)
$
24. Describe miscellaneous costs (engineering costs, administrative fees, feasibility study Total Cost of 24
costs, etc.).
$
Portion Claiming Tax Exempt (provide itemized list)
$

25. Value of recovered product (must provide per Sec. 5902(2)) Total of 19-24
$ $
26. Is equipment replacing an existing piece of equipment already exempt? Yes No
If Yes, enter the Tax Exemption Certificate number ____________________________________

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3828, Page 3 TE-PROCESS

Application for Air Pollution Control Tax Exemption Certificate
Process Change Description - Complete only if changing a current process to a new improved process
PART 6: ORIGINAL PROCESS AND ALTERNATIVE (THEORETICAL) CONVENTIONAL CONTROL
27. AQD Source ID (SRN) 28. Emission Unit

29. Describe the original process and the operational procedure of this emission unit, with specific attention paid to the portion(s) of the process being
changed. (A detailed narrative is critical.)

30. Describe or list the air pollution control devices employed by the original process.

31. Describe the type and magnitude of pollutants associated with this emission unit. 32. Permit Number/ Permit
Exemption Rule (must provide
one)

33. Describe a control device that could have been employed to reduce emissions to the same extent as the process 33a. Estimated cost of
change. Give details concerning whether or not it could (physically) have been done, and whether or not it would be theoretical/conventional control
as effective as the process change at controlling pollution. (See Example 1 in instructions). (33 and 33a must be
completed)
$

PART 7: NEW PROCESS - The shaded area in items 43 and 44 are for Office Use Only.
34. Describe the process and the operational procedure of this emission unit, with specific attention being paid to the portion(s) of the process that
were/are being changed. Provide plans, specifications and drawings showing position of equipment relative to outer shell of building.

35. Describe the air pollution control devices employed by the new process. IMPORTANT: A TE-EQUIPMENT form should be submitted for
equipment that is solely used for air pollution control.

36. Describe the type and magnitude of pollutants associated with this new emission unit.

37. Emission Unit 38. Permit Number/ Permit 39. Beginning Date of 40. Projected/Actual Completion
Exemption Rule (if different from Construction
item 28)

41. Total Cost of Process Change 42. Portion Claiming Tax Exempt 43. Exemption Factor 44. Exemption Value
$ $ 25% or __________% $
45. Gross Value of Recovered Product
$

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3828, Page 4

Instructions for Completing Form 3828,
Application for Air Pollution Control Tax Exemption Certificate
GENERAL INSTRUCTIONS Classification (SIC) code that best describes the major product or
One TE-SOURCE is required for each submittal; and one or both service produced. This code must be a four digit numeric code not
TE-EQUIPMENT or TE-PROCESS is also required. Complete ending in zero based upon the Standard Industrial Classification
the number of forms appropriate for your situation. Multiple Manual (1987), or a six-digit code based upon the North American
TE-Equipment and TE-Process forms may be filed under one Industry Classification System (1997).
TE-Source [IMPORTANT: Forms must be fully completed. Part 2: Technical Contact/Preparer Information
An incomplete application will be returned to the preparer Enter the information in #8 of the person who can respond to
unprocessed.] technical questions about the application. If the Preparer is different
For full consideration in the year in which the material is than Technical Contact Person, enter the Preparer information in
submitted, a complete application must be received by June 15. #9.
For faster service, email the completed application and Part 3: Company Official
additional required documentation to PTE@michigan.gov. An The Company Official is required to be an employee of the
additional submission option is to mail the completed application company that is seeking the tax exemption. The application
and required documents to:Michigan Department of Treasury, State response will be sent to the Company Official. By signing and
Tax Commission, P.O. Box 30471, Lansing, MI 48909 dating this application, the Company Official authorizes the
Refer to the following Department of Environmental Quality Michigan Department of Treasury and the DEQ to discuss this
(DEQ) Web site documents for assistance in completing an air project with the technical contact person named in Part 2.
pollution control tax exemption application: TE-EQUIPMENT
DEQ Air Quality Web site The TE-EQUIPMENT provides information about air pollution
www.michigan.gov/deq/0,1607,7-135,3310---,00.html control equipment that may be eligible for tax exemption. If a tax
DEQ Air Pollution Guidance Document exemption is being sought for equipment from multiple emission
units, complete a separate form for each emission unit. A separate
w w w. d e q . s t a t e . m i . u s / d o c u m e n t s / D E Q - A Q D - should be attached for each additional explanation. Each page
page
Tax_exemption_application_guidance_document.pdf must be identified as TE-Equipment or TE-Process along with the
DEQ Permit Guide Book corresponding Emission Unit name from box 14. Applications with
more than one explanation per page will not be accepted. Items 19
www.deq.state.mi.us/documents/deq-ess-
permitspermitguidebook.pdf thru 24 may require additional space for explanation.
DEQ Operational Memorandum #6 – Emissions Units Part 4: General Information
www.deq.state.mi.us/documents/deq-aqd-opmemo6.pdf Line 13: AQD Source ID (SRN). Enter the state registration
number for your facility issued by the DEQ.
DEQ Environmental Permits,Licenses & Certifications
Line 14: Emission Unit. If the equipment is part of a Renewable
http://www.michigan.gov/deq/1,1607,7-135-6132_6830---,00. Operating Permit, Permit to Install, or is reported in the Michigan
html Air Emission Reporting System (MAERS), it may have an
LINE-BY-LINE INSTRUCTIONS emission unit associated with it. If so, enter thename of the
Lines not listed are explained on the form. Complete all boxes or emission unit to which it belongs. If not, the Michigan Department
indicate N/A. of Environmental Quality, Air Quality Division (DEQ/AQD),
“Operational Memorandum No. 6” will assist you in defining
TE-SOURCE one for your facility. A separate TE-EQUIPMENT should be
The TE-SOURCE provides general information about the facility submitted for each emission unit. Multiple TE-Process and TE-
including contact person and preparer identification. Complete a Equipment forms may be filed under one TE-Source.
TE-SOURCE for each submittal. If additional space is required Permit Number/Exemption Rule. Enter the permit number
Line 16:
to complete an answer, attach additional pages. or permit exemption rule that covers the process equipment. One
must be provided.
Part 1: Source Identification Part 5: Equipment and Cost Details
This section pertains to the facility where the air pollution control Provide a description of the equipment associated with the air
equipment is located. pollution control that is claimed to be exempt. Provide one set of
Line 2: AQD Source ID (SRN). Enter the state registration plans and provide an itemized list of equipment and costs. Consider
number for your facility issued by the DEQ. incremental costs when providing the value to be considered for
tax exemption. If a building is constructed solely for the purpose
Line 3: Primary SIC Code. Enter the Standard Industrial

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3828, Page 5

of protecting an air pollution control device, the entire cost of the Line 45: Value of Recovered Product. Enter the gross commercial
building may be tax exempt. If, however, the size of the building or productive value derived from any materials captured or
is increased to allow for additional warehouse space, the entire recovered by the air pollution control equipment, calculated
cost of the building would not be tax exempt. (See Example 1) on a yearly basis. Include any financial benefit from increased
Line 25: Value of Recovered Product. Enter the gross commercial production capabilities as a result of a change in the process. This
or productive value derived from any materials captured or is required per Sec. 5902(2).
recovered by the air pollution control equipment calculated on a
yearly basis. This is required per Sec. 5902(2).
TE-PROCESS
The TE-PROCESS provides detailed cost information about a
process change that has contributed to an improvement in air
emission. A tax exemption of up to 25% is awarded for eligible
equipment. If a tax exemption is being sought for equipment
from multiple emission units, complete a separate form for
each emission unit. If additional space is required to complete
an answer, attach additional pages. A separate page should
be attached for each additional explanation. Each page must
be identified as TE-Equipment or TE-Process along with the Example 1
corresponding Emission Unit name from box 14. Applications A building is constructed to protect an air
with more than one explanation per page will not be accepted. pollutioncontrol device and serve as a warehouse.
Items 29 thru 36 may require additional space for explanation. To calculate the tax exempt portion, the applicant
must determine the total cost of the building, less
Part 6: Original Process and Alternative
the cost of the portion of the building serving as a
(Theoretical) Conventional Control warehouse.
Line 27: AQD Source ID (SRN). Enter the state registration Total Cost of Building $100,000
number for your facility issued by the DEQ.
Less Cost of Warehouse Portion (80,000)
Line 28: Emission Unit. If the equipment is part of a Renewable Tax Exempt Portion $20,000.
Operating Permit, Permit to Install, or is reported in the
Michigan Air Emission Reporting System (MAERS), it may
have an emission unit associated with it. If so, enter the name
of the emission unit to which it belongs. If not, the Michigan
Department of Environmental Quality, Air Quality Division, Example 1
“Operational Memorandum No. 6” will assist you in defining an Case 1: A $200,000 process change to a coating line
emission unit for your facility. A separate TE-PROCESS should results in lower VOC emission. Theoretically, a
be submitted for each emission unit. Multiple TE-Process and thermal oxidizer and capture equipment could have
TE-Equipment forms may be filed under one application. had the same net decrease in emission, but would’ve
cost $100,000. In this case, a 25% tax exemption for
Part 7: New Process
the process change would be appropriate, thereby
Line 37: Emission Unit. If the new equipment is part of a making $50,000 eligible for tax exemption.
Renewable Operating Permit, Permit to Install, or is reported in
Case 2: A $500,000 process change to a coating line
the Michigan Air Emission Reporting System (MAERS), it may
results in lower VOC emission. Theoretically, a
have an emission unit associated with it. If so, enter the name of
thermal oxidizer and capture equipment could have
the emission unit to which it belongs. It is possible that it will
had the same net decrease in emission, but would’ve
have the same name as that listed on line 28.
cost $100,000. In this case, the $100,000 control
Line 41: Total Cost of Process Change. Enter the total cost of equipment addition would’ve had the same net
the process change, not including costs of air pollution control effect, and is less than 25% of $500,000 ($125,000).
devices listed in TE-EQUIPMENT. Therefore, in this case, a tax exemption of $100,000
Line 42: Portion Claiming Tax Exempt. A standard 25% of costs would be issued, even though the $500,000 process
associated with process changes is tax exempt. Enter the portion change was the actual action taken.
of the total cost for which you are claiming a tax exemption. (See
example 2)

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