GRANT PAYMENT REQ UEST
FORM Tax Year 201 2
TAXPAYER
Property Owner’s Name:
DBA (Doing Business As):
Mailing Address:
Address of Actual Location of Property or Facility:
Taxpayer ID / Social Security Number:
Telephone Number:
E-mail:
Airport Related Business: Air Charter Aircraft Aircraft Maintenance
Avionics Car Rental Flight Training Hangar Rental
Other (explain)
Account Number or Tax Receipt (Copy Attached):
Date Paid:
TAXPAYER SIGNATURE
I declare that I am current in my tax obligations to the County and City, located within the Airport
Development Area and engaged in an “Airport-Related Business”. I further declare that all of the above
information is true and correct to the best of my knowledge and belief.
Print Name:
Title: Date:
Property Owner’s Signature:
COUNTY (For Office Use Only)
Approved: Date: Amount:
Vendor #: 101-4112-410-8438
CITY (For Office Use Only)
Approved: Date: Amount:
Vendor #: Account #:
Reset
Print
G R A N T P A Y M E N T R E Q U E S T F O R M
I n s t r u c t i o n s
1) Complete Taxpayer Section. Please fill in all requested information.
a) The address of actual location of property or facility should be inside the Airport Development
Area.
b) Enter your Taxpayer Identification or Social Security Number.
Important: This is required of all requests. If the business is a proprietorship, enter the
Social Security Number of the owner.
c) Check the airport related business. If your airport related business is not listed, please explain
what the business is in the space provided.
d) List the account number from your tax bill or the tax receipt number from your receipt of taxes
paid. Please attach a copy of the bill or receipt to the Form.
e) Property owner’s signature is required.
2) Mail the completed Form on or before March 30, 2013, with the supporting documentation, to the Rowan County
Finance Department at the address below:
Rowan County Finance Department
Attention: Suzanne Burgess
130 West Innes Street
Salisbury, NC 28144
If you have any questions, please call Suzanne Burgess at 704-216-8178.
Once the County approves the Grant Payment Request Form, the Finance Department will mail a check
for the County’s portion, with explanation of incentive grant calculation, to the mailing address on the
Form. The County will then forward the information to the City. The Taxpayer will receive a separate
check from the City.