Please complete in Black Ink/Biro.

1. Description of heritage item(s) in respect of which a Determination is sought. Please provide, where appropriate, visuals such as photographs etc in support of your application.

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2. Details of when the heritage item(s) was/were acquired by you and proof of ownership. Include the price paid in the last transaction and the date of purchase (if known). ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................

3. Indicate briefly why you consider the heritage item(s) to fall within the criteria requiring Determination. Please include any historical information known to you.

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4. Please provide your estimate of the current value of the heritage item(s) or a professional valuation if same is available.

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5. Indicate to which Approved Body you intend donating the heritage item(s)

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6. Please state when, if the Determination is successful, you would propose actually donating the gift to the Approved Body.

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7. How may an inspection of the heritage item(s) be arranged? In this regard the Selection Committee and/or the Revenue Commissioners or agents of the Revenue Commissioners may wish to view and/or discuss the heritage item(s) with you or your professional valuer in order to process your application effectively and efficiently.

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Tax Relief for Donations of Heritage Items

Section 1003 Taxes Consolidation Act, 1997

Declaration by Individual Owner/Joint Owners

I/we formally declare that I am/we are the owner(s) of the heritage item(s) described above. For the purpose of making application under Section 1003 of the Taxes Consolidation Act, 1997 for tax relief for donations of heritage items, I/we apply for a Determination by the Selection Committee that the heritage item(s) in question is/are an item(s) or collection of items which is –

1. an outstanding example of the type of item involved, pre-eminent in its class, whose export from the State would constitute a diminution of the accumulated cultural heritage of Ireland or whose import into the State would constitute a significant enhancement of the accumulated cultural heritage of Ireland, and
2. suitable for acquisition by an Approved Body.

Name(s) 1. ........................................................................................

Declaration by Company/Partnership/Business

We formally declare that we are the owners of the heritage item(s) described above. For the purpose of making application under Section 1003 of the Taxes Consolidation Act, 1997 for tax relief for donations of heritage items, we apply for a Determination by the Selection Committee that the heritage item(s) in question is/are an item(s) or collection of items which is –

1. an outstanding example of the type of item involved, pre-eminent in its class, whose export from the State would constitute a diminution of the accumulated cultural heritage of Ireland or whose import into the State would constitute a significant enhancement of the accumulated cultural heritage of Ireland, and
2. suitable for acquisition by an Approved Body.