Renewable Energy System Certification

Investment Cost Recovery Incentive Program

82.16 RCW

Instructions for Filing: Please mail or fax this Department of Revenue Tax Reporting Number
certification form to the Washington State Department of (If you do not have a number, one will be assigned.)
Revenue at the address below. The Department will: (1)
forward this form to the Climate and Rural Energy − −
Development Center at Washington State University, and
(2) advise the applicant within 30 days of receipt of this
form whether the renewable energy system qualifies for Name, Address, and Phone Number of Applicant
the investment cost recovery incentive program.
Definitions:
Customer-generated electricity: The alternating current
electricity that is generated from a renewable energy
system located on an individual’s, business’, or local Telephone No. ( ) (Required)
government’s real property and is provided electricity
generated by a light and power business. A system Location of Renewable Energy System
located on a leasehold interest does not qualify under this
definition. It also does not include electricity generated (If different from above address)
by a light and power business with greater than 1,000
megawatt hours of annual sales or a gas distribution
business.
Solar inverter: The device used to convert direct current
to alternating current in a photovoltaic cell system.
Does the electricity produced meet the definition of
Photovoltaic cell: A device that converts light directly “customer generated electricity?”
into electricity without moving parts.
Yes No
Solar module: The smallest nondivisible self-contained
physical structure housing interconnected photovoltaic
cells and providing a single direct current electrical output. What does the renewable energy system produce
electricity with?
Mail to:
Department of Revenue ♦ Solar inverters and solar modules manufactured
Taxpayer Account Administration in Washington State
PO Box 47476 ♦ A wind generator powered by blades
Olympia WA 98504-7476 manufactured in Washington State
♦ A solar inverter manufactured in Washington
FAX to: (360) 586-0527 State
♦ A solar module manufactured in Washington
State
For Official Use Only − Approval Signatures
♦ Solar or wind equipment manufactured
Department of Revenue
outside of Washington State
♦ An anaerobic digester
Date: / /
Can the electricity be transformed or transmitted for
entry into or operation in parallel with electricity
Climate & Rural Energy Development Center − WSU transmission and distribution systems? Yes No
What is the permit number and the date the renewable
Date: / / energy system received its final electrical permit from
the local jurisdiction?
Permit No: Date:

For tax assistance, visit http://dor.wa.gov or 1-800-647-7706. To inquire about the availability of this document in an alternate format
for the visually impaired, please call (360) 705-6715. Teletype (TTY) users may call 1-800-451-7985.
REV 41 0094 (7/19/05)