Assessor’s Use Onl
List #
Town Code
District Code
2019 GRAND LIST
MANUFACTURING MACHINERY AND EQUIPMENT EXEMPTION CLAIM
This exemption claim form should accompany the Personal Property Declaration filed annually in order to properly receive the
exemption provided under C.G.S. §12-81(76) as amended by PA 14-183, sections 2, 3 & 4. The following definitions are applicable for
purposes of Public Act 11-61 Sec. 2 and referenced in Sec. 3.
Machinery and equipment means tangible personal property which is installed in a manufacturing facility and claimed on the owner's
federal income tax return as either five-year property or seven-year property, as those terms are defined in Section 168(e) of the
Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as from time to time
amended, and the predominant use of which is for manufacturing, processing or fabricating; for research and development, including
experimental or laboratory research and development, design or engineering directly related to manufacturing; for the significant
servicing, overhauling or rebuilding of machinery and equipment for industrial use or the significant overhauling or rebuilding of other
products on a factory basis; for measuring or testing or for metal finishing; or used in the production of motion pictures, video and sound
recordings
This form must be filed on or before November 4, 2019. Claims must be filed annually with the municipal Assessor by any person
seeking the exemption provided under C.G.S. §12-81(76), as amended, for manufacturing machinery and equipment and installed in a
manufacturing facility. If extension to file is requested and granted, a late filing fee based on the value of the assessment is required.
Contact your assessor for extension requests and fees provided under 12-81K and amended by PA 14-183, sections 2, 3, and 4.
This form is to be filed in the town in which the machinery and equipment is installed
Manufacturer Information: (Lessor: provide Lessee information) Lessor Information:
Name Name
Business
Address
Business
Address
City/
State/Zip
City/
State/Zip
Person to be contacted if there are any questions: Required Identification Numbers
Name Connecticut State Tax ID No.
Title Federal Taxpayer ID No.
Address
Benefits and Exempt Status Questions Yes or No
Phone/Fax
/
Are you currently receiving benefits under CGS. §12-81 (60)
OR (70) Distressed Municipality Program?
E-mail
Is the machinery and equipment for which you are seeking
exempt status depreciable on your books for IRS purposes?
Property Location (Number, street, and town where machinery and
equipment is installed.)
If no, on whose books are these assets depreciated?
Check which description best applies and complete the detail description below:
1
manufacturing, processing or fabricating
2
measuring or testing
3
metal finishing
4
the significant overhauling or rebuilding of
other products on a factory basis
5
used in the production of motion pictures,
video and sound recordings
6
used in connection with biotechnology
7
research and development, including
experimental or laboratory research and
development, design or engineering
directl
related to manufacturin
8
the significant servicing, overhauling or
rebuilding of machinery and equipment
for industrial use
9
used in connection with recycling, as
defined in C.G.S. §22a-260, if acquired
and installed on or after July 1, 2006
Describe the business activity (in specific terms), which conforms to the above definition of manufacturing. Indicate the product manufactured:
