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Form Ur-J - Application For Eligibility - Urban Job Tax Credit Program - Florida Department Of Economic Opportunity Page 5

FORM UR-J

Rev. 07/01

URBAN JOB TAX CREDIT PROGRAM

FORM UR-J: APPLICATION FOR ELIGIBILITY

(pursuant to s. 212.097, F.S.)

Date of Application:

Has this business submitted an urban job tax credit application previously?

YES

If yes, date of previous application:

Business Name:

Federal Employer Identification Number:

Florida Unemployment Insurance Compensation Number:

Mailing Address:

Business Location:

(if different from

mailing address)

Contact Person:

Phone Number:

FAX:

The applicant is applying as:

A NEW BUSINESS or as

AN EXISTING BUSINESS

First Day of Operations at this location:

Standard Industrial Classification Code:

Urban Area Number:

UA-

TIER:

Most Recent Tax Year:

TOTAL GROSS RECEIPTS:

GROSS RECEIPTS from activities associated with the above SIC CODE (most recent tax year):

RETAIL RECEIPTS (most recent tax year):

(Note: receipts from retail sales are to be excluded except for businesses in SIC 52-57, 59, 70, 7992 and 7996.)

Is the business a “Small Business” as defined in subsection 288.703 (1), Florida Statutes?

YES

C:\Documents and Settings\dev17536\My Documents\Business Development\UJTCP_Application.doc

Form Ur-J - Application For Eligibility - Urban Job Tax Credit Program - Florida Department Of Economic Opportunity Page 5