Harris County Appraisal District
Industrial Valuation Division
13013 Northwest Fwy.
P. O. Box 922005
Houston, TX. 77292-2005
(713) 957-5619
11.33
(08/04)
Application for Exemption of Raw Cocoa and
Green Coffee Held in Harris County for
year
This application covers property you owned on January 1 of this year. You must file the completed application between January 1
and April 30 of this year. Be sure to attach any additional document(s) requested. If the chief appraiser grants the exemption, you
do not have to apply annually. However, you must reapply if the chief appraiser requires you to do so. You must notify the chief
appraiser in writing if and when your right to this exemption ends. Once you have filled out the on-line form, you must print it,
sign it, and mail or deliver the form to the address above
. If you have any questions please call the number above
* You are required to give us this information on this form, in order to perform tax related functions for this office. Section 11.43
of the Tax Code authorizes this office to request this information to determine tax compliance.
Step 1. Owner's Name and Address
Owner's Name
Telephone (area code and number)
Current Mailing Address (number and street)
City, State
ZIP Code + 4
Name of Person Preparing this Application
Title
Driver's License, Personal I.D. Certificate, or Social Security Number*
Authorized Agent's Name (if different from above)
Telephone (area code and number)
Mailing Address (number and street)
City, State
ZIP Code + 4
1. HCAD Account Number (Give the appraisal roll account number if available or attach a copy of a tax bill or appraisal or tax office
correspondence conerning this account.)
2. Location of Inventory (street address)
3. City, State
4. ZIP Code + 4
Step 4. Sign and Date Application
I certify that the information provided on this form is true and correct to the best of my knowledge and belief.
sign
here
Date
On Behalf of (Name of Corporation/Company)
Title
If you make a false statement on this application, you could be found guilty of a Class A misdemeanor or a state jail
felony
under Texas Penal Code Section 37.10.
5.
Give total cost of raw cocoa held in Harris County on January 1,
5. $
6.
Give total cost of green coffee held in Harris County on January 1,
6. $
Step 2. Describe the Property
Step 3. Answer These Questions About your Property
>
Authorized Signature
