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Form Rev 81 1013 - High Technology Application For Tax Deferral 82.63 Rcw And Wac 458-20-24003 Page 2

16. Percentage of facility devoted to:

a) Pilot scale manufacturing

b) Research & development

c) Other

17. Will this project create a new business operation?

Yes

18. If the answer to question 17 is no, what is the present true and fair value (assessed value) of the existing plant complex

owned by the applicant to be expanded, modernized, or re-equipped as a result of the tax deferral project?

a) Structure(s)

b) Machinery

c) Total

19. Will the facility housing the operations be leased by applicant?

Yes

20. Will the new structure(s) be built by a lessor who will pass on this tax exemption benefit to a

lessee?

Yes

21. Will the ownership of the newly constructed leased structure be vested in the same person as the

applicant?

Yes

If question 20 or 21 is yes, attach form REV 81 1012, “High Technology Application for Tax Deferral for Lessor.”

22. Total statewide full- time positions for this business

23. Total full-time positions prior to project at this site

24. New full-time positions to be created as a result of this project

25. Estimated average annual wage per employee filling new positions

26. Will new positions be filled by transfer of employees from within the state?

¨ Yes

¨ No

If yes, how many? ___________________

27. The processing of this application may require the submission of additional data, statements, and other

information to the Department of Revenue in order to comply with the administrative and statutory

requirements of the law.

NOTICE: Applications and other information received by the Department under this chapter are not confidential and are

subject to disclosure. Only non-proprietary information is required on this application.

Keep a copy of completed form for your records

To inquire about the availability of this form in an alternate format for the visually impaired or in a

language other than English, please call (360) 753-3217. Teletype (TTY) users may call (800) 451-7985.

You may also access tax information on our Internet home page at

REV 81 0013-2 (3-17-99)

Form Rev 81 1013 - High Technology Application For Tax Deferral 82.63 Rcw And Wac 458-20-24003 Page 2