Enterprise Zone Program
Real Property 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)
Fax:
Real Property Tax Information
Existing Real Property:
Tax Map #: _________________________________
Tax Parcel Code #:___________________________
_____Year Assessment: ____________________and
Tax:________________________
Attach copy of CURRENT tax bill
For Office Use Only:
Real Property With Improvements:
Tax Map #: _________________________________
Tax Parcel Code #:___________________________
_____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 Real Property Assessment and Tax
Real Property information, assessment, tax are correct:
Yes
No
Comments:
Date:__________________ Commissioner of the Revenue:____________________________________
Treasurer/Central Accounting - Verification of Real Property IDA Tax Grant
Refund from this filing: Year 1_________________ Years 2-5_________________ per year
Comments:
Date:_____________________ Treasurer:_____________________________________________
Please print name: ______________________________________
