Form 150-303-029 - Oregon Enterprise Zone Authorization Application Page 2
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OREGON EMPLOYMENT OUTSIDE THE ENTERPRISE ZONE
Check only those that apply:
Check here if your firm or a commonly controlled firm is, or will be, closing or curtailing operations in the state beyond 30 miles of the zone’s
boundary. Indicate timing, location, number of any job losses, and relationship to the proposed enterprise zone investment:
_______________________________________________________________________________________________________________
Check here if you are transferring any operations into the zone from site(s) within 30 miles of the zone boundary (existing businesses only):
My firm’s average employment at the site(s) over the past 12 months is __________________ jobs.
Check here if your firm commits to increase the combined employment at the site(s) (within 30 miles) and in the zone to 110 percent of the
existing combined level by April 1 and on average during the first year of exemption.
PROPOSED INVESTMENT IN QUALIFIED PROPERTY
Anticipated Timing—Enter dates or months/years
Site and Building & Structures
Machinery and Equipment
Action
Preparation
Construction*
Placed in Service
Procurement**
Installation
Placed in Service
To commence
or begin on
To be com-
pleted on
* And/or new reconstruction, additions to, or modifications of existing building(s) or structure(s).
** May precede application by up to three months.
Special Issues:
Check here for building/structure acquired/leased for which construction, reconstruction, additions, or modifications began prior to this appli-
cation (attach executed lease or closing documents).
Check here for Work-in-Progress tax exemption for qualified property that is not yet placed in service and is located on site as of January 1.
(Attach description and list of such probable property. See “Special Issues Worksheet,” on the last page.)
Qualifying Property: Estimates of cost (please attach a preliminary list of machinery and equipment).
Check if any
Number of
Expected
Type of Property
Item will be
Each/Item
Estimated Value
Leased
Building or structure to be newly constructed
$
Real Property
New addition to or modification of an existing building/structure
$
Heavy or affixed machinery and equipment
$
$50,000 or more
$
Personal Property
Item(s) Costing:
$1,000 or more (E-commerce zone or used exclusively for tangible production)
$
Total Estimated Value of Investment
$
Additional 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.
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
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 285C) and complies with all local, Oregon, and federal laws that are applicable to my business.
MUST BE SIGNED BY AN OWNER, COMPANY EXECUTIVE, OR AUTHORIZED REPRESENTATIVE OF THE BUSINESS FIRM
Signature
Date
X
Title (if not an owner or executive, attach letter attesting to appropriate contractual authority)
Local enterprise zone manager and county assessor must approve this application (with Enterprise Zone Authorization Approval, form 150-303-082)
150-303-029 (Rev. 10-10)
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