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ECONOMIC DEVELOPMENT AD VALOREM PROPERTY TAX EXEMPTION DR-418 Chapter 196.1995, Florida Statutes R. 12/99 To be filed with the Board of County Commissioners,the governing boards of the municipality,or both, �... no later than March 1 of the year the exemption is desired to take effect. 1 Business name Imailing address 2 Please give name and telephone number of owner or person in charge of this business. Name I Telephone number 3 Exact Location(Legal Description and Street Address)of Property for which this return is filed 4-Date you began,or will begin,business at this facility 5 Description of the improvements to real property for which this exemption is requested Date of commencement of construction of improvements 6 Description of the tangible personal property for which this exemption is requested and date when property was,or is to be purchased APPRAISER'S USE ONLY Date of Taxpayer's Estimate of Class or Item Age Purchase I Original Cost Cond* Fair Market Rent Cond* $ $ $ $ $ $ $ $ y$,$ $ $ $ $ $ Average value of inventory on hand: *Condition:good, avg (average), or poor Any additional personal property not listed above for which an exemption is claimed must be returned on form DR-405(Tangible Personal Property Tax Return)and a copy attached to this form. 7 Do you desire exemption as a 0 new business or 0 expansion of an existing busines 9 Trade levels(check as many as apply) 11 Describe type or nature of your business E] Retail E]Wholesale Manufacturing Professional Service Q Office Other,specify: 10 Number of full-time employees to be employed in Florida If an expansion of an existing business: Net increase % Increase in productive output in employment resulting from this expansion 11 Sales factor for the facility requesting exemption: Total sales in Florida from this divided ITotal sales everywhere from this _ facility-one(1)location only I by facility-one(1)location only -J 12 For office space owned and used by a Date of incorporation Number of full-time corporation newly domiciled in Florida lin Florida employees at this location I hereby request the adoption of an ordinance granting an exemption from ad valorem taxation on the above property pursuant to Section 196.1995,Florida Statutes.I agree to furnish such other reasonable information as the Board of County Commissioners,the governing authority of the municipality,or the Property Appraiser may request in regard to the exemption requested herein.I hereby certify that the information and valuation stated above by me is true, correct,and complete to the best of my knowledge and belief.(If prepared by someone other than the taxpayer,his declaration is based on all information of which he has any knowledge.) Date Signature,preparer Preparer's address Signature,taxpayer Title Preparer's telephone number Property Appraiser's Use Only I Total revenue available to the county or municipality for the current fiscal year from ad valorem tax sources $ II Revenue lost to the county or municipality for the current fiscal year by virtue of exemptions previously granted under this section $ III Estimate of the revenue which would be lost to the county or municipality during the current fiscal year if the exemption applied $ for were granted and the property for which the exemption is requested would otherwise have been subject to taxation IV Estimate of the taxable value lost to the county or municipality if the exemption applied for was granted Improvements to real property $ Personal property $ I have determined that the property listed above meets the definition,as defined by Section 196.012(15)or(16),Florida Statutes,as a 0new business Dexpansion of an existing business Oneither �V_l Last year for which exemption may be applied Application to be filed not later than March 1 Date Signature,Property Appraiser AWWA nI,...�,:.� 144