Nevada Pollution Control Affidavit Form

AFFIDAVIT
Claim for Property Tax Exemption of Pollution Control Facilities
Under the Provisions of NRS 361.077
By:
Owner of Facility
______ _____ Assessor ID# 99-
Fiscal Year___________________
The types of property upon which tax exemption is claimed under this act consists of the following:
DESCRIPTION OF PROPERTY
PURPOSE
LAWS OR
REGULATIONS TO BE
COMPLIED WITH
INSTALLATION
DATE
INSTALLATION
COST
LOCATION
I,
, state on oath that the above claim for property tax exemption is made in good faith and is to the best of my knowledge
and belief true, correct and complete and that the use of said property included in the above exemption claim is for the primary
prim
purpose of complying
with laws for the prevention, control or reduction of air and water pollution. The property included in the above exemption claim is not used as: (1)
an air conditioner, (2) a septic tank, or (3) a sewage facility used to move sewage to collection facilities. Each property or facility included in the
above exemption claim does not produce a net profit to it
itss owner or operator from the recovery and sale, or, use of a tangible product or byproduct,
nor does such use result in a net reduction of operating costs. Further, I hereby authorize and empower Nevada taxing authorities
author
and their deputies
to personally inspect the facilities, examine supporting documents or otherwise verify the above exemption claim(s).
Subscribed and sworn to before me this _______ day of________________, 20_______.
_____________________________________
Taxpayer or Authorized Representative
____________________________
Notary Public
ADDITIONAL ATTACHMENT(S)
DESCRIPTION OF PROPERTY
Page _____ of ______
PURPOSE
LAWS OR
REGULATIONS TO BE
COMPLIED WITH
INSTALLATION
DATE
INSTALLATION
COST
LOCATION