Financial Services 
                                                                                         Sales Tax Division 
                                                                                         215 North Mason Street, 2 ndFloor 
                                                                                         P.O. Box 580 
                                                                                         Fort Collins, CO 80522 
                                                                                         970.221.6780 
                                                                                         970.221.6782 - fax 
                                                                                         fcgov.com/salestax 

                                  Manufacturing Equipment Use Tax Rebate Application 
                                                              202 1

Taxpayer (Company) Name                                                 Fort Collins License Number  

Mailing Address                                                         Phone Number   

                                                                        Email Address 

Contact Person 

                                    The following information is mandatory for the rebate process. 
          All financial information contained in this application will be confidential pursuant to City Code § 25-166 and applicable law. 
Manufacturing Information: 
Date manufacturing operations began in Fort Collins 
What does your company manufacture? 
Square footage of Fort Collins manufacturing facility  
Square footage of entire Fort Collins facility 
20 20real property tax valuation                              2020personal property tax valuation  
202 1real property tax valuation                              202 1personal property tax valuation  
Who is your natural gas provider?                             Annual Gas Consumption 
Rebate Information: 
Purchase price of manufacturing equipment purchased in 202 : 1
Amount of rebate requested:  

Taxpayer authorizes the City to review and consider sales and use tax records, vendor records, contract and other information available regarding 
Taxpayer’s eligibility for a rebate under this program.   

I certify that Taxpayer is in compliance with all federal, state and local laws and regulations for the manufacturing facility located in Fort Collins.  I also 
certify that Taxpayer is current with all City of Fort Collins contractual, payment and sales and use tax obligations. 

I declare under penalty of perjury that this claim (including any accompanying schedules and statements) has been examined by me and to the best of 
my knowledge and belief is true and made in good faith for the stated purpose.  Further, I represent and warrant that I have the necessary authority to 
execute this application on behalf of Taxpayer, and to make the above certifications, authorizations, and declaration. 

A claim by an agent must be accompanied by power of attorney. 

Signature of Taxpayer                                             Title                                                 Date 

OTHER INFORMATION 

You must provide a list of the manufacturing equipment purchased that includes the following: 

                                        1.        Invoice number 

                                        2.        Invoice date 

                                        3.        Vendor name 

                                        4.        Description of machinery purchased 

                                        5.        Intended use of the machinery 

                                        6.        Date the use tax was paid to the City of Fort Collins

                                        7.        Purchase price of the equipment 

                                        8.        Amount of purchase subject to Fort Collins tax

                                        9.        Amount of Fort Collins use tax paid 

You are not required to submit copies of the invoices for which the rebate is requested.  However, in the event there are questions regarding the 
eligibility of certain equipment, supporting documentation, including invoices, will be required. 

Applications must be submitted no later than June 30, 2022. 

Submit applications and list of equipment purchased to: 

                                        City of Fort Collins 

                                        Sales Tax Division 

                                        Attn: Danielle Wallace  

                                        P.O. Box 580 

                                        Fort Collins, CO  80522-0580 

For specific questions regarding the rebate program, call Danielle Wallace at (970) 416-4246 or danwallace@fcgov.com. 

For general sales and use tax questions, call the Sales Tax Office at (970) 221-6780. 

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