Form 150-303-029 - Oregon Enterprise Zone Precertification Application (Page 2 of 2) in pdf

INVESTMENT

Anticipated Timing — Dates or months/years.

Site

Machinery and Equipment

Building Construc-

Action

Preparation**

Occupancy

Procurement

Installation**

Usage

tion / Modification**

To commence

or begin on

To be

completed by

**Must begin no sooner than the submission of this application and be completed by Dec. 31 before the initial year of the exemption.

Check here for building acquired/leased after (re)construction that began prior to this application (attach executed lease).

Qualifying Property — Estimates of cost (please attach a preliminary list of machinery and equipment).

Expected

Type of Property

Estimated Cost

New building(s) or structure(s) each costing $25,000 or more

Additions to/modification of existing building or structure (total cost at least $25,000 per single building/structure)

Real property (attached to building or other real property/not readily movable)

Machinery

and

Personal property items costing $50,000 or more

Equipment

(please attach list)

Personal property items costing $1,000 or more and used exclusively in tangible production

TOTAL ESTIMATED COST OF INVESTMENT (minimum $25,000)

Summary Description — in addition to what is explained elsewhere, briefly comment below (or in an attachment) on the scope of your

investment, the particular operations and output that are planned, and the intended uses of the qualifying property.

SPECIAL CASES (see instructions)

Extended Abatement —

Check here if you are requesting up to 2 additional years of exemption and committing to the accompanying requirements. If the

request is granted, the local zone manager will attach the written agreement with the zone sponsor and fill out the following:

For Zone

Total length

150% of county average annual wage: $________________

Additional reasonable requirements request-

Manager

of exemption: __________ years.

(except for urban zones in the Portland area)

ed by the zone sponsor?

Yes

Use Only

Additional Urban Conditions —

Check here if you are subject to additional conditions imposed under the policy/standards set by the sponsor of an urban enter-

prise zone. (If so, the local zone manager must attach a form detailing these conditions and your firm’s related commitments.)

Other Allowed Circumstances — Check all that apply, for general information, and include appropriate attachments:

Tax exemption for construction-in-process (CIP/separate application).

Leasing of any qualifying property.

Incentives of local sponsoring jurisdiction(s) to be provided.

Public real estate available for sale or lease.

Two corporations under common ownership treated as one firm.

Partial occupancy of a qualifying building or structure.

Investment of $25 million or more by existing business not

Investment subject to a change in the zone boundary.

meeting employment requirements (attach resolutions).

Site located inside of a terminated zone and business firm

is “grandfathered” by prior ongoing investment/exemption.

Briefly explain checked items:

DECLARATION

I declare under penalties of false swearing (ORS 305.990(4)) that I have examined this document and attachments, and to the best of my knowledge,

they are true, correct and complete. If any information changes, I will notify the zone manager and the county assessor and submit appropriate written

amendments. I understand that my business firm will receive the tax exemption for property in the enterprise zone, only if my firm satisfies statutory

requirements (ORS Chapter 285 B) and complies with all local, Oregon and federal laws that are applicable to my business.

Signature of Authorized Representative of Business Firm

Date

Local enterprise zone manager and county assessor must approve this application (with form 150-303-082, the precertification approval).