Manufacturing Machinery Exemption form - 23GL

Assessor’s Use Only 
List # 
Town Code 
District Code 
2023 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 1, 2023 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 
NAICS/SIC  Code 
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 
directly related to manufacturing 
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: 

INSTRUCTIONS 
IMPORTANT: Read the descriptions of Personal Property Code #10 and Code #13 before completing the application for 
exemption. To ensure that you receive the appropriate exemption, you must report the total cost of machinery and 
equipment (i.e., original cost, excluding sales tax, plus the cost of transportation and installation) under the appropriate 
category code. 
Code # 10: 
Machinery and equipment not eligible for exemption under CGS §12-81(76): Industrial or manufacturing machinery 
and equipment the owner claims or claimed on a federal income tax return as three-year property (e.g., tools, dies, jigs, 
patterns, etc.) or ten-year or greater property (i.e., property that has a class life of more than 16 years). Air and water 
pollution control equipment, regardless of its class life does not meet the predominant use criteria for exemption under 
CGS. §12-81(76). Machinery and equipment located in a Distressed Municipality, Enterprise Zone or Enterprise Corridor 
Zone  (regardless of its class life) which were included on DECD M47 form and you are filing Form M-55 to claim the 
property tax exemption under CGS §12-81(60) or (70).  
Code # 13: 
Machinery and equipment eligible for exemption under CGS §12-81(76): Manufacturing machinery and equipment 
acquired and installed, that is predominantly used for manufacturing or biotechnology, or used in connection with recycling 
(as defined in CGS §22a-260) and the owner or lessee of such machinery and equipment claims it on a federal income tax 
return as five-year property or seven-year property. To obtain the exemption under CGS §12-81(76),the owner or 
lessee who claims such property on a federal income tax return must file this exemption application.
Complete this form in its entirety, including the itemized listing of manufacturing machinery and equipment by 
year of acquisition. 
#13 –  Manufacturing machinery & equipment Eligible for exemption 
Year Ending 
Original Cost 
Transportation & Installation 
% Value 
Net Depreciated 
Value 
Assessor’s 
Approved Total 
Cost 
Assessor’s 
Approved 
Depreciated Value 
10-1-2023 
 
 
95% 
10-1-2022 
90% 
10-1-2021 
80% 
10-1-2020 
70% 
10-1-2019 
60% 
10-1-2018 
50% 
10-1-2017 
40% 
Prior Yrs 
30% 
Total 
I hereby certify that I am eligible for the property tax exemption provided under CGS §12-81(76).  I further certify that all machinery and 
equipment listed herein was acquired and installed in the above named manufacturing facility, continues to be located there and is 
predominantly used for a manufacturing purpose.  I agree to maintain and make available upon request to the Assessor or the Board of 
Assessors, supporting documentation, including, but not limited to, invoices, bills of sale, and bills of lading pertaining to the machinery 
and equipment for which   I am claiming exempt status.  I do hereby declare under penalty of false statement that the information 
contained herein is true and complete to the best of my knowledge, remembrance and belief, and that I am authorized to make 
application for this property tax exemption.  I request that the cost information submitted herein be kept confidential. 
Signature 
 Date 
Print or type name of signer and title 
Failure to file this form in the manner and form, and within the time limit prescribed, shall result in the assessor not applying 
the exemption allowed under CGS §12-81(76). 
SIGN

Itemized Listing of Manufacturing Machinery and Equipment 
2022 Grand List 
INSTRUCTIONS:  
 
Print or type only. You may submit a computer printout containing all 
required Information In the prescribed format.  
 
List only manufacturing machinery and equipment eligible under CGS 12-
81 (76).  See definitions. 
 
Do Not Include Sales Tax. 
 
All monetary amounts should be rounded to the nearest whole dollar.
 
Lessees are to provide only their transportation and installation costs 
(purchase price will be obtained from lessor). 
 
For leased property, enter Lease ID # beneath the name and address of 
the lessor. 
 Provide IRS Classification* Please refer to IRS Code Section 168(e), ie: 
(A)(iii) or (B)(ii).  Do not provide class life.
TERMS: 
 
Total cost of acquisition is the price paid for the property, including the 
value of a ‘trade-in’, plus the cost of transportation and installation.  (If 
installation required real property structural changes, the cost of such 
changes cannot be included.) 
 
The purchase price for self-constructed machinery and equipment is the 
unit cost.
 
Date installed for leased property is the beginning date of the lease.
Inaccurate information may affect qualification for exemption. 
The information requested on this form is essential to the 
applicant or machinery and equipment qualifying for 
exemption.  Regardless of past practices, applications 
submitted which are incomplete or do not conform to the 
prescribed format will not be accepted.  Description of 
machinery and equipment should be complete and readily 
identifiable.  Property described as “miscellaneous”, 
“manufacturing machinery or equipment”, or numeric entries 
are not acceptable.
Property Description & Model ID # 
# of  
Items 
Date 
Acquired 
Mo./Day/Yr. 
Date  
Installed 
Mo./Day/Yr. 
IRS* 
Classifi- 
cation 
Purchase 
Price 
Transportation/ 
Installation  
Cost 
Total Cost 
of Acquisition 
Page Total 
Grand Total 
Failure to file this form in the manner and form, and within the time limit prescribed, shall result in the assessor not applying the exemption allowed under CGS §12-81(76). 
.
0

Property Description & Model ID # 
# of  
Items 
Date 
Acquired 
Mo./Day/Yr. 
Date  
Installed 
Mo./Day/Yr. 
IRS* 
Classifi- 
cation 
Purchase 
Price 
Transportation/ 
Installation  
Cost 
Total Cost 
of Acquisition 
*Property shall be treated as:
If it has a class life (in years) of:
5 year property . . . . . . . . . . . . . . . . . . . . . .more than 4 but less than 10
 7 year property. . . . . . . . . . . . . . . . . . . . . . . 10 or more but less than 16
Page Total 
Grand Total 
0
0