Certification Application Long-Term Rural Oregon Tax Incentive Form

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CERTIFICATION APPLICATION
Long-Term Rural Oregon Tax Incentive
ORS 285C.400–285C.420
• Complete this form and submit to the local enterprise zone manager and the county assessor before breaking ground or beginning work at the site.
• Please type or print neatly.
ELIGIBLE LOCATION (see #3 on the back)
County
Rural Enterprise Zone
APPLICANT
Telephone Number
Name of Business Firm
(
)
City
State
ZIP Code
Mailing Address
City
State
ZIP Code
Location of Property (street address if different from above)
Title
Map and Tax Lot No. of Site
Contact Person
DEFINING THE FACILITY
Description of operations and overall physical plant when the proposed facility is placed in service: (attach additional pages)
Property or improvements to be purchased, constructed, or installed:
Square Footage/Acreage/
Type of Property
Estimated Cost
Number of Units or Items
New buildings and structures
$
and land to be acquired
New additions/modifications to
$
existing buildings and structures
Real property (attached
New machinery
$
to building/real property)
and equipment
Personal property
(please attach list)
$
(readily movable)
Total Estimated Cost of New Investment
$
Assessed value of all real and personal property currently at the site of the
proposed facility/investment
$
Construction, hiring, and commencing operations:
• Construction is expected to begin ..................................................................................................................
___________________
• Hiring is expected to begin (month/year) .......................................................................................................
___________________
• Facility is expected to be first placed in service/operations beginning (month/year) .....................................
___________________
• Final construction of facility property is expected to be completed (month/year) ..........................................
___________________
• Hiring is expected to be completed (month/year) ..........................................................................................
___________________
• Estimated total of full-time employees to be hired by the firm for new facility................................................
___________________
CORPORATE EXCISE TAX CREDITS
Will applicant seek the 5 to 15-year tax credit under ORS 317.124?
Yes*
No
If yes, the tax credit would be requested to begin in the tax year starting on: _______________________________________________
_____________
* Must be approved, in writing, by the governor of the state of Oregon and begin no later than the third calendar year after the year in which the facility is
placed in service. It is not sought until after certification. The facility must be owned by a corporation.
150-310-073 (Rev. 10-10)

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