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Form Ur-J - Application For Eligibility - Urban Job Tax Credit Program - Florida Department Of Economic Opportunity Page 9

FORM UR-J

Rev. 07/01

URBAN JOB TAX CREDIT PROGRAM

SINGLE BUSINESS ENTITY AFFIDAVIT

(To accompany an Application For Eligibility Form UR-J)

The undersigned (an authorized corporate officer or a registered dealer) hereby

acknowledges that our firm

(Federal Employer Identification Number:

) is submitting

a sole Application For Eligibility (Form UR-J) dated

for the Urban

Job Tax Credit Program.

Pursuant to the definition of a “eligible business” in Section 212.097(1)(a), Florida

Statutes, which states “commonly owned and controlled entities are to be considered a single

business entity,” we hereby acknowledge that our firm (whether an individual store or a

multitude of stores commonly owned and operated by the corporation) shall be classified as a

“single business entity” for the purposes of the Urban Job Tax Credit Program.

The firm acknowledges that at this time it may submit only one Application For

Eligibility on behalf of all businesses within the firm’s ownership and control that are located in

a designated high-crime area and qualify for the Urban Job Tax Credit Program, in accordance

with Section 212.097, Florida Statutes.

The firm acknowledges the businesses listed in the attached Application for Eligibility

is/are its designee(s) to apply for an Urban Job Tax Credit and it is our understanding that our

firm

will not be eligible to submit

another Application For Eligibility until twelve (12) months from the date of the application that

we are submitting at this time.

Business Name

Authorized Signature

Date

Printed Name

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 9