Form 891 "Application for Water Pollution Control Tax Exemption Certificate" - Michigan

What Is Form 891?

This is a legal form that was released by the Michigan Department of Treasury - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2014;
  • The latest edition provided by the Michigan Department of Treasury;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 891 by clicking the link below or browse more documents and templates provided by the Michigan Department of Treasury.

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Download Form 891 "Application for Water Pollution Control Tax Exemption Certificate" - Michigan

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Michigan Department of Treasury
891 (Rev. 04-14)
Application for Water Pollution Control Tax Exemption Certificate
Issued under authority of Public Act 451 of 1994, as amended, Part 37. Filing is mandatory.
General Information. Complete All Boxes.
New
Amended
Transfer Certificate #2
PART 1: SOURCE INDENTIFICATION
(This section pertains to the facility where the water pollution control equipment is located).
1. Company Name (applicant must be owner of facility)
2. County
3. Address (equipment location)
4. City, State, ZIP Code
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 file under 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
(Name and address for Tax Exemption response. Complete all boxes).
10. Company Official Name
Position/Title
Street Address
City, State, ZIP Code
E-mail
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 ONLY
Application Number
Reviewed By
Date Recieved/Date Reviewed
LUCI Code
Reset Form
Michigan Department of Treasury
891 (Rev. 04-14)
Application for Water Pollution Control Tax Exemption Certificate
Issued under authority of Public Act 451 of 1994, as amended, Part 37. Filing is mandatory.
General Information. Complete All Boxes.
New
Amended
Transfer Certificate #2
PART 1: SOURCE INDENTIFICATION
(This section pertains to the facility where the water pollution control equipment is located).
1. Company Name (applicant must be owner of facility)
2. County
3. Address (equipment location)
4. City, State, ZIP Code
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 file under 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
(Name and address for Tax Exemption response. Complete all boxes).
10. Company Official Name
Position/Title
Street Address
City, State, ZIP Code
E-mail
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 ONLY
Application Number
Reviewed By
Date Recieved/Date Reviewed
LUCI Code
TE-EQUIPMENT
891, Page 2
Application for Water Pollution Control Tax Exemption Certificate
Water Pollution Control Equipment Description
PART 4: GENERAL INFORMATION
11. Describe the water pollution control equipment, the operational procedure, how it will minimize or control water pollution, and any function the equipment
serves. Include non-water pollution control uses.
12. Beginning Date of Construction
13. Projected/Completion Date of Construction
PART 5: EQUIPMENT AND COST DETAILS (
For the equipment associated with the water 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 of the facility as an additional attachment per Section 3702(1). Provide an itemized list of equipment totaling the
amount requested in box #7).
14. Describe the water pollution control equipment. (attach additional pages if necessary. Costs must be
Total Cost of 14
separated into appropriate categories in sections 14 thru 16).
Portion Claiming Tax Exempt (Provide itemized list)
15. Describe the ancillary equipment (foundations, enclosures, electrical equipment,
Total Cost of 15
wastewater storage, chemical treatment storage tanks, pumps, piping, instrumentation &
sludge dewatering equipment, etc.)
Portion Claiming Tax Exempt (Provide itemized list)
16. Describe miscellaneous costs (engineering, administrative fees, etc.)
Total Cost of 16
Portion Claiming Tax Exempt (Provide itemized list)
17. Value of recovered product (must provide per Sec. 3702(2))
$
Total of 14-16
891, Page 3
Instructions for Completeing Form 891, Application for
Water Pollution Control Tax Exemption Certificate
GENERAL INSTRUCTIONS
Each page must be identified as TE- Equipment. Items 11, 14, 15
and 16 may require additional space for explanation.
One TE-SOURCE is required for each submittal; and one TE-
EQUIPMENT is also required. [IMPORTANT: Forms must be
Part 5: Equipment and Cost Details
fully completed. An incomplete application will be returned
Provide a description of the equipment associated with the water
to the preparer unprocessed.]
pollution control that is claimed to be exempt.
For full consideration in the year in which the material is submitted,
Consider incremental costs when providing the value to be
a complete application must be received by June 15. Mail THREE
considered for tax exemption. If a building is constructed solely
COPIES (no binders) of the completed forms and supplemental
for the purpose of protecting a water pollution control device, the
information (written narrative, list of equipment with individual
entire cost of the building may be tax exempt. If, however, the
costs, one set of plans) to:
size of the building is increased to allow for additional warehouse
Michigan Department of Treasury
space, the entire cost of the building would not be tax exempt.
State Tax Commission
(See Example 1.)
P.O. Box 30471
Lansing, MI 48909-7971
Line 16. Value of Recovered Product.
Enter the gross
Telephone: 517-373-2408
commercial or productive value derived from any materials
captured or recovered by the water pollution control equipment
For guaranteed receipt by the State Tax Commission, it is
calculated on a yearly basis. This is required per Sec. 3702(2).
recommended that applications and attachments are sent by
certified mail.
Example 1
A building is constructed to protect a water pollution control device
LINE-BY-LINE INSTRUCTIONS
and serve as a warehouse. To calculate the tax exempt portion,
Lines not listed are explained on the form. Complete all boxes or
the applicant must determine the total cost of the building, less
indicate N/A.
the cost of the portion of the building serving as a warehouse.
TE-SOURCE
Total Cost of Building
$100,000
The TE-SOURCE provides general information about the facility
including contact person and preparer identification. Complete a
Less Cost of Warehouse Portion
(80,000)
TE-SOURCE for each submittal. If additional space is required to
complete an answer, attach additional pages.
Tax Exempt Portion
$20,000
Part 1: Source Identification
This section pertains to the facility where the water pollution
control equipment is located.
Part 2: Technical Contact/Preparer Information
Enter the information in number 8 of the person who can respond
to technical questions about the application. If the Preparer is
different than Technical Contact Person, enter the Preparer
information in number 9.
Part 3: Company Official
The Company Official is required to be an employee of the
company that is seeking the tax exemption. The application
response will be sent to the Company Official. By signing and
dating this application, the Company Official authorizes the
Michigan Department of Treasury and the Michigan Department
of Environmental Quality to discuss this project with the technical
contact person named in Part 2.
TE-EQUIPMENT
The TE-EQUIPMENT provides information about water pollution
control equipment that may be eligible for tax exemptions. A
separate page should be attached for each additional explanation.
Page of 3