Fillable Enterprise Zone Program Office Furniture, Fixtures & Equipment (County of Henry)

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Enterprise Zone Program Office Furniture, Fixtures & Equipment (County of Henry)

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U.S.A. forms for County of Henry

BROWSE COUNTY OF HENRY (VA) FORMS

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County of Henry
Enterprise Zone Program
Office Furniture, Fixtures & Equipment Investment Plan/IDA Grant Form
Business Information
(Please Type or Print)
Name of Business:
Phone:
Fax:
Address:
City/State/Zip:
Project Location: (Tax Map Designation and Road or Street Name, or E-911 Structure Address if Known)
NAICS Code(s):
Zoning Code(s):
Contact Person:
Phone:
Fax:
Office Furniture, Fixtures & Equipment
Tax Information
Existing Office Furniture, Fixtures & Equipment:
FIN#:______________________________________
Tax Account #:______________________________
_____Year Assessment: ___________________ and
Tax:_______________________
Attach copy of CURRENT tax bill
For Office Use Only:
Revised Office Furniture, Fixtures & Equipment:
FIN#:______________________________________
Tax Account #:______________________________
_____Year Assessment: ____________________and
Tax:________________________
Filer's Statement - I hereby declare that, to the best of my knowledge and belief, the information contained
in this form is true and accurate and that I am authorized to act on behalf of the business.
Date Submitted:____________________ Authorized Signature:_________________________________
Commissioner of the Revenue– Verification of Office Furniture, Fixtures & Equipment Assessment and Tax
Machinery & Tools information, assessment, and tax are correct:
Yes
No
Comments:
Date:___________________ Commissioner of the Revenue:___________________________________
Treasurer/Central Accounting- Verification of Office Furniture, Fixtures & Equipment IDA Tax Grant
Refund from this filing: Year 1___________________ Years 2-5____________________ per year
Comments:
Date:_____________________ Treasurer:_________________________________________
Please print name: _______________________________________
Enterprise Zone Investment Plan/IDA Grant Form
Page 2
Office Furniture, Fixtures & Equipment Investment Data
Give a brief description of the project which includes information on the following points:
* List New Office Furniture, Fixtures, & Equipment
Placed in Service in Year ________
Quantity
Add-A
Replaced-R
Original Cost
Per Item
_____________________________________________________
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Total Costs: $________________
* If not enough space provided attach typed list in same format and label as Exhibit "A"
* * List Office Furniture, Fixtures, & Equipment
Taken Out of Service in Year _______
Quantity
Year Placed
In Service
Original Cost
Per Item
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Total Costs: $_______________
* * If not enough space provided attach typed list in same format and label as Exhibit "B"
Current Number of Jobs: ________ Jobs To Be Retained: _________ Jobs To Be Created: _________
For Office Use Only: Do Not Write Below This Line:
County Administrator Review
Meets overall goals and objectives:
Yes
No
Meets incentive guidelines & procedures
Yes
No
Comments:____________________________________________________
Date:________________________ County Administrator:__________________________________
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Enterprise Zone Program Office Furniture, Fixtures & Equipment (County of Henry)

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Completed 17 July 2020

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