Form 49E Property Tax Exemption Election Form

(Describe what the asset is including make model and serial number) (Identify beginning and ending dates) (If additional space is required complete additional pages ) (If additional space is required complete page 2 ) 06 27 12 Asset Asset Description Asset Located County in Which Date Placed EFO00031 EFO00031p2 ELECTION I elect to exempt the following property that was placed in service during calendar year 2012 from property tax for 2013 and 2014 I understand I forgo my right to claim the investment tax credit on this property at any time Once I make the election I cannot revoke it I will be subject to recapture of the property tax benefit if during the 5 year recapture period the property no longer qualifies as a qualified investment as defined in Section 63 3029B Idaho Code Form 49E Page 2 FROM PROPERTY TAX IN LIEU OF INVESTMENT TAX CREDIT I elect to claim the QIE on the property listed as follows The exemption for used property is limited See instructions IDAHO ELECTION TO CLAIM THE QUALIFIED INVESTMENT EXEMPTION If this corporation is included in a combined report enter the name of the corporation the Idaho income tax return is filed under if different than above If you had a short period tax year during calendar year 2012 or during the previous two years attach a statement identifying your tax year ending dates in Service LOSS IN SECOND PRECEDING TAX YEAR To qualify for the QIE you must have had an Idaho income tax loss without regard to net operating loss carry overs or carrybacks in the second preceding tax year from the income tax year you placed the property in service If you file income tax returns on a fiscal year basis see the instructions to determine your qualifying loss years County assessors are allowed to check with the Tax Commission to verify you had a loss in the applicable year(s) New or Number Original Cost Print Contact Name Contact Phone Number Provide the ending date of your tax year(s) that ended in calendar year 2012 Qualifying Loss Year Signature Date Social Security Number or EIN To elect the QIE you must attach this form to the operator s statement or personal property declaration(s) filed for 2013 You must also include a copy of your original Idaho income tax return(s) for the tax year(s) in which the property was placed in service Under penalties of perjury I affirm that to the best of my knowledge and belief the property listed on Form 49E is qualified investment property as defined in Section 63 3029B Idaho Code and that I have not or will not claim the Idaho investment tax credit on the listed property Use this form to elect the qualified investment exemption (QIE) from property tax for property placed in service during calendar year 2012