Form Rev 81 1024e - Corporate Headquarters Application For Sales And Use Tax Deferral For Lessor 82.82 Rcw Page 2
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1
2
3Business Activity to be Conducted at this Facility
Employment Information
7. Lessee’s average number of full time equivalents (FTEs) for
If additional space is needed to answer questions 1 and 2, please
previous calendar year.
attach additional pages.
(1820 annualized hours worked = 1 FTE):
1. Describe the nature of your activity at this facility.
Lessee’s entire business:
______________
At this facility:
______________
8. Estimated number of new FTEs as
Yes
No
a result of this project.
______________
2. Is the investment project located in a
Community Empowerment Zone (CEZ)
9. Estimated average annual wage per
as defined in RCW 43.31C.020?
employee filling new positions:
______________
3. Will you have 300 or more employees at
Lessee information
this facility?
10. Name of Lessee:
11. Mailing Address:
12. Contact Person:
Apportionment of Structure
13. Phone Number:
4. Percentage of facility devoted to:
14. Department of Revenue Tax Reporting Account
Accounting/Payroll
%
Number:
Yes
No
Administration
%
15. Do the lessee and lessor have 100%
Cafeteria
%
same ownership?
Common Areas
%
16. If the answer to question 15 is "Yes", please provide
Conference & Training Rooms
%
documentation to substantiate the relationship.
Customer Service
%
17. If the answer to question 15 is "No", has the lessor agreed
Manufacturing
%
by written contract to pass the economic benefit of the
Packing or Packaging
%
deferral to the lessee?
Plant offices used by direct line
18. If the answer to question 17 is “Yes”, is the economic
supervisors or other managers who
benefit of the deferral passed to the lessee no less than the
oversee the manufacturing process
%
amount of the tax deferred by the lessor and evidenced by
Processing
%
written documentation of the type of payment, credit, or
Reception Area
%
other financial arrangement between the lessor or owner of
the qualified building and the lessee AND has the lessee
Research & Development
%
signed the statement below agreeing to complete the annual
Sales & Marketing
%
tax incentive survey required by RCW 82.82.020?
Warehouse
%
Other (please describe)
%
Please have the lessee sign the following statement. Failure
Total
100 %
to do so will prevent approval of the application.
I agree to file an annual tax incentive survey with the
Estimated Investment Project Costs
th
Department of Revenue each April 30
for eight years,
beginning with the first calendar year after the calendar year
5. Structure:
in which the investment project is certified by the
department as operationally complete.
Date construction/expansion to start
Name ________________________________________
Construction of new structure(s)
Signature ______________________________________
Leasehold improvements paid for by
applicant
Title __________________________________________
Expansion or renovation to expand
Date
floor space or production capacity
(Please attach a completed Lessee's Application, if
Total Structure Costs
applicable, a copy of the lease agreement and other written
documentation in support of your answers to question 17
6. Estimated completion date
and 18, if applicable)
REV 81 1024e (8/18/11)
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