Reset Form Michigan Department of Treasury TE-SOURCE 3828 (Rev. 05-13) 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 |
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 ____________________________________ |
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 $ |
3828, Page 4 Instructions for Completing Form 3828, Application for Air Pollution Control Tax Exemption Certificate GENERAL INSTRUCTIONS Part 1: Source Identification One TE-SOURCE is required for each submittal; and one or both This section pertains to the facility where the air pollution control TE-EQUIPMENT or TE-PROCESS is also required. Complete equipment is located. the number of forms appropriate for your situation. Multiple Line 2: AQD Source ID (SRN). Enter the state registration number TE-Equipment and TE-Process forms may be filed under one for your facility issued by the DEQ. TE-Source [IMPORTANT: Forms must be fully completed. Line 3: Primary SIC Code. Enter the Standard Industrial An incomplete application will be returned to the preparer Classification (SIC) code that best describes the major product or unprocessed.] service produced. This code must be a four digit numeric code not For full consideration in the year in which the material is ending in zero based upon the Standard Industrial Classification submitted, a complete application must be received by June 15. Manual (1987), or a six-digit code based upon the North American Mail THREE COPIES (no binders) of the completed forms and Industry Classification System (1997). supplemental information (written narrative, list of equipment Part 2: Technical Contact/Preparer Information with individual costs, one set of plans) to: Enter the information in #8 of the person who can respond to Michigan Department of Treasury technical questions about the application. If the Preparer is different State Tax Commission than Technical Contact Person, enter the Preparer information in P.O. Box 30471 #9. Lansing, MI 48909-7971 Telephone: 517-335-7491 Part 3: Company Official The Company Official is required to be an employee of the For guaranteed receipt by the State Tax Commission, it is company that is seeking the tax exemption. The application recommended that applications and attachments are sent by response will be sent to the Company Official. By signing and certified mail. dating this application, the Company Official authorizes the Michigan Department of Treasury and the DEQ to discuss this Refer to the following Department of Environmental Quality project with the technical contact person named in Part 2. (DEQ) Web site documents for assistance in completing an air pollution control tax exemption application: TE-EQUIPMENT The TE-EQUIPMENT provides information about air pollution DEQ Air Quality Web site control equipment that may be eligible for tax exemption. If a tax www.michigan.gov/deq/0,1607,7-135,3310---,00.html exemption is being sought for equipment from multiple emission DEQ Air Pollution Guidance Document 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 - page should be attached for each additional explanation. Each page must be identified as TE-Equipment or TE-Process along with the Tax_exemption_application_guidance_document.pdf corresponding Emission Unit name from box 14. Applications with DEQ Permit Guide Book more than one explanation per page will not be accepted. Items 19 www.deq.state.mi.us/documents/deq-ess- thru 24 may require additional space for explanation. permitspermitguidebook.pdf Part 4: General Information DEQ Operational Memorandum #6 – Emissions Units Line 13: AQD Source ID (SRN). Enter the state registration www.deq.state.mi.us/documents/deq-aqd-opmemo6.pdf 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 emission unit associated with it. If so, enter thename of the LINE-BY-LINE INSTRUCTIONS emission unit to which it belongs. If not, the Michigan Department Lines not listed are explained on the form. Complete all boxes or of Environmental Quality, Air Quality Division (DEQ/AQD), indicate N/A. “Operational Memorandum No. 6” will assist you in defining TE-SOURCE one for your facility. A separate TE-EQUIPMENT should be submitted for each emission unit. Multiple TE-Process and TE- The TE-SOURCE provides general information about the facility Equipment forms may be filed under one TE-Source. including contact person and preparer identification. Complete a TE-SOURCE for each submittal. If additional space is required Line 16: Permit Number/Exemption Rule. Enter the permit number to complete an answer, attach additional pages. or permit exemption rule that covers the process equipment. One must be provided. |
3828, Page 5 Part 5: Equipment and Cost Details Line 41: Total Cost of Process Change. Enter the total cost of Provide a description of the equipment associated with the air the process change, not including costs of air pollution control pollution control that is claimed to be exempt. Provide one set devices listed in TE-EQUIPMENT. of plans and provide an itemized list of equipment and costs. Line 42: Portion Claiming Tax Exempt. A standard 25% of costs Consider incremental costs when providing the value to be associated with process changes is tax exempt. Enter the portion considered for tax exemption. If a building is constructed solely of the total cost for which you are claiming a tax exemption. (See for the purpose of protecting an air pollution control device, the example 2) entire cost of the building may be tax exempt. If, however, the Line 45: Value of Recovered Product. Enter the gross commercial size of the building is increased to allow for additional warehouse or productive value derived from any materials captured or space, the entire cost of the building would not be tax exempt. recovered by the air pollution control equipment, calculated (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 Example 1 process change that has contributed to an improvement in air A building is constructed to protect an air emission. A tax exemption of up to 25% is awarded for eligible pollutioncontrol device and serve as a warehouse. equipment. If a tax exemption is being sought for equipment To calculate the tax exempt portion, the applicant from multiple emission units, complete a separate form for must determine the total cost of the building, less each emission unit. If additional space is required to complete the cost of the portion of the building serving as a an answer, attach additional pages. A separate page should warehouse. be attached for each additional explanation. Each page must be identified as TE-Equipment or TE-Process along with the Total Cost of Building $100,000 corresponding Emission Unit name from box 14. Applications Less Cost of Warehouse Portion (80,000) with more than one explanation per page will not be accepted. Tax Exempt Portion $20,000. Items 29 thru 36 may require additional space for explanation. Part 6: Original Process and Alternative (Theoretical) Conventional Control Line 27: AQD Source ID (SRN). Enter the state registration Example 1 number for your facility issued by the DEQ. Case 1: A $200,000 process change to a coating line Line 28: Emission Unit. If the equipment is part of a Renewable results in lower VOC emission. Theoretically, a Operating Permit, Permit to Install, or is reported in the thermal oxidizer and capture equipment could have Michigan Air Emission Reporting System (MAERS), it may had the same net decrease in emission, but would’ve have an emission unit associated with it. If so, enter the name cost $100,000. In this case, a 25% tax exemption for of the emission unit to which it belongs. If not, the Michigan the process change would be appropriate, thereby Department of Environmental Quality, Air Quality Division, making $50,000 eligible for tax exemption. “Operational Memorandum No. 6” will assist you in defining an Case 2: A $500,000 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, the $100,000 control Part 7: New Process equipment addition would’ve had the same net Line 37: Emission Unit. If the new equipment is part of a effect, and is less than 25% of $500,000 ($125,000). Renewable Operating Permit, Permit to Install, or is reported in Therefore, in this case, a tax exemption of $100,000 the Michigan Air Emission Reporting System (MAERS), it may would be issued, even though the $500,000 process have an emission unit associated with it. If so, enter the name of change was the actual action taken. the emission unit to which it belongs. It is possible that it will have the same name as that listed on line 28. |