State Form 52108 Form Agq-100 - Agricultural Equipment Exemption Usage Questionnaire - Indiana

Form State52108 is a Indiana Department of Revenue form also known as the "Form Agq-100 - Agricultural Equipment Exemption Usage Questionnaire". The latest edition of the form was released in September 1, 2017 and is available for digital filing.

Download an up-to-date Form State52108 in PDF-format down below or look it up on the Indiana Department of Revenue Forms website.

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Form
Indiana Department of Revenue
AGQ-100
Agricultural Equipment Exemption Usage
State Form 52108
Questionnaire
(R3 / 9-17)
Information furnished below is subject to audit verification.
Full Legal Name of Purchaser (Print)
Federal Identification Number (FID)/Social Security Number (SSN)
Street Address
City
State
ZIP Code
Email
Phone
(1) Describe your equipment purchase (attach a copy of your invoice). _________________________________________________
(2) Are you occupationally engaged in agriculture for a living?
Yes
No Do you file a Federal Schedule F?
Yes
No
(3) List accessories used with this equipment. ____________________________________________________________________
For the section below, list your best estimate of daily use over a year’s time period that this equipment is utilized for various activities. A
single day could have multiple uses and the total days used do not have to equal 365. If the listed activities do not describe your usage,
please write in a new description that fits your situation in one of the Other Use lines. You may attach additional pages or pictures, if
needed (see page 2 for instructions).
Please indicate below the equipment usage for the purchase described in (1) above. Check all that apply.
Number of
Number of
Equipment Usage
Days Used
Equipment Usage
Days Used
Application of crop seed
Picking up rocks/debris from field
Application of fertilizer
Transporting farmer/employees
Mowing or spraying of ditches, field boundaries,
Application of insecticide/fungicide
and barn yard areas
Hauling seeds, fertilizer and insecticide/
fungicide to fields
Maintenance of sod farms
Hauling or removal of manure from
livestock barn/enclosure
Snowplowing
Hauling feed to livestock
Soil sampling and testing
Tilling land for crops to be sold
Repairing/inspection of fence
Harvesting crops (not transporting)
Corralling Livestock
Transporting of crop (field to storage)
Hunting
Field/pasture/livestock inspections
Other Use ___________________________
Recreational Riding
Other Use ___________________________
Hauling Tools and Equipment
Other Use ___________________________
Hauling trash/garbage
Other Use ___________________________
I certify, under penalty of perjury, the information contained in this questionnaire is true, correct and complete to the best of my
knowledge and belief.
Purchaser’s Signature: ___________________________
Title: ________________________
Date: __________________
Mail to: Indiana Department of Revenue
This agency is requesting the disclosure of your Social
Audit Division/Desk Audit
Security number in accordance with IC 4-1-8-1. Disclosure
100 N. Senate Ave., IGCN-241
is mandatory; this record cannot be processed without it.
Indianapolis, IN 46204-2253
Form
Indiana Department of Revenue
AGQ-100
Agricultural Equipment Exemption Usage
State Form 52108
Questionnaire
(R3 / 9-17)
Information furnished below is subject to audit verification.
Full Legal Name of Purchaser (Print)
Federal Identification Number (FID)/Social Security Number (SSN)
Street Address
City
State
ZIP Code
Email
Phone
(1) Describe your equipment purchase (attach a copy of your invoice). _________________________________________________
(2) Are you occupationally engaged in agriculture for a living?
Yes
No Do you file a Federal Schedule F?
Yes
No
(3) List accessories used with this equipment. ____________________________________________________________________
For the section below, list your best estimate of daily use over a year’s time period that this equipment is utilized for various activities. A
single day could have multiple uses and the total days used do not have to equal 365. If the listed activities do not describe your usage,
please write in a new description that fits your situation in one of the Other Use lines. You may attach additional pages or pictures, if
needed (see page 2 for instructions).
Please indicate below the equipment usage for the purchase described in (1) above. Check all that apply.
Number of
Number of
Equipment Usage
Days Used
Equipment Usage
Days Used
Application of crop seed
Picking up rocks/debris from field
Application of fertilizer
Transporting farmer/employees
Mowing or spraying of ditches, field boundaries,
Application of insecticide/fungicide
and barn yard areas
Hauling seeds, fertilizer and insecticide/
fungicide to fields
Maintenance of sod farms
Hauling or removal of manure from
livestock barn/enclosure
Snowplowing
Hauling feed to livestock
Soil sampling and testing
Tilling land for crops to be sold
Repairing/inspection of fence
Harvesting crops (not transporting)
Corralling Livestock
Transporting of crop (field to storage)
Hunting
Field/pasture/livestock inspections
Other Use ___________________________
Recreational Riding
Other Use ___________________________
Hauling Tools and Equipment
Other Use ___________________________
Hauling trash/garbage
Other Use ___________________________
I certify, under penalty of perjury, the information contained in this questionnaire is true, correct and complete to the best of my
knowledge and belief.
Purchaser’s Signature: ___________________________
Title: ________________________
Date: __________________
Mail to: Indiana Department of Revenue
This agency is requesting the disclosure of your Social
Audit Division/Desk Audit
Security number in accordance with IC 4-1-8-1. Disclosure
100 N. Senate Ave., IGCN-241
is mandatory; this record cannot be processed without it.
Indianapolis, IN 46204-2253
Instructions for Completing Form AGQ-100
Notice: The fact that an item is purchased for use on the farm does not necessarily make it exempt from sale (sic) tax. The fact that
a piece of equipment is convenient, necessary or essential to farming is insufficient in itself to determine if it is used directly in direct
production as required to be exempt.
Your purchase will not be considered exempt without all the information requested on this form including the name of the purchaser,
full address, a copy of a detailed purchase invoice attached to the form AGQ-100, indicating the purchase date, location, price, delivery
location and any trade-in, identification number, full description of the equipment, all of the uses made of the equipment and the number
of days for each use. To help expedite your possible exemption, please provide a telephone number and email address (if available).
See our Administrative Code Title 45 IAC 2.2-5-1 through 7 for our agricultural regulations which can be found at
www.in.gov/legislative/
iac/iac_title?iact=45. Additional information is available through Sales Tax Information Bulletin #9 at www.in.gov/dor/3650.htm.
Form AGQ-100 should be completed separately for each item purchased exempt. Form AGQ-100 (Agricultural Equipment Exemption
Usage Questionnaire) can be located at www.in.gov/dor/3504.htm. Enter the number of days for each use. A use day may be any part
of a day when you use the equipment for that activity. A single day could include multiple activities and the total days do not need to
equal 365. For spraying or mowing activity please explain what is being sprayed or mowed in detail.
For further clarification of a possible exemption, please send pictures of the equipment in use.
Individual taxpayers not filing a Federal Schedule F may be denied the agricultural exemption.
A copy of the completed Form AGQ-100 submitted should be retained for your records.
Information remitted on this form is subject to audit verification.
Previous editions of this form are obsolete.

Download State Form 52108 Form Agq-100 - Agricultural Equipment Exemption Usage Questionnaire - Indiana

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