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FORM UT - 3: APPLICATION FOR A CERTIFICATE (Naugatuck Valley Council of Governments)

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(UT-3, PAGE 1)
CT DECD, 450 Columbus Boulevard, Suite 5 | Hartford, CT 06103-1843 | Phone: 860-500-2300
An Affirmative Action/Equal Opportunity Employer an Equal Opportunity Lender
FORM UT - 3
APPLICATION FOR A “CERTIFICATE OF ELIGIBILITY”
for tax incentives under Sec. 12-81(59) and Sec. 12-81(60) of Connecticut General Statutes (check zone below)
__ Airport Development Zones
__ Enterprise Zones
__ Manufacturing Plant Zone
__ Bioscience Enterprise Corridor Zone
__ Enterprise Corridor Zones
__ Qualified Manufacturing Plant
__ Contiguous Municipality Zone
__ Entertainment Districts
__ Railroad Depot Zones
__ Defense Plant zone
__ Urban Jobs
SECTION I:
(A) Legal name (as registered with the Secretary of the State) of business seeking tax benefits,
full mailing address, telephone number(s), and email(s) of the owner(s) of the facility (the
real property) for which a “Certificate of Eligibility” is being requested. Please attach a copy
of the Connecticut Secretary of the State’s Certificate of Legal Existence (Good Standing).
Telephone:
Email:
(B) Legal name (as registered with the Secretary of the State), full mailing address, telephone
number(s), and email of the business occupant of the facility identified in Section 1(A)
above, and for which a “Certificate of Eligibility” is being requested.
Telephone:
Email:
(C) Name, full mailing address, telephone number(s), and email(s) of the person(s) to whom
questions and other communications about the facility should be addressed.
Telephone:
Email:
(D) Name and title, full mailing address, telephone number(s), and email(s) of the person(s) to
whom questions and other communications about the business occupant of the facility listed
in Section 1(B) above should be addressed.
Telephone:
Email:
(UT-3, PAGE 2)
CT DECD, 450 Columbus Boulevard, Suite 5 | Hartford, CT 06103-1843 | Phone: 860-500-2300
An Affirmative Action/Equal Opportunity Employer an Equal Opportunity Lender
(E) The North American Industry Classification (NAICS) number of the business occupant of
the facility identified in Section 1(B), above (free look-up at
https://www.census.gov/eos/www/naics/):
(F) Fiscal Year of the business occupant of the facility identified in above Section I(B) of this
application.
Calendar (ending December 31)
(G) Form of Business Organization of the occupant of the facility identified in Section I(B) of
this application (Check One):
Corporation, Partnership, Proprietorship, LLC, “S” Corp., Other
If incorporated, provide the name of the State in which incorporated and the date of
incorporation:
Provide the date on which the business occupant identified in Section I(B) was first
registered to conduct business in the State of Connecticut:
(H) Is the owner of the facility identified in Section I(A) of this application also an occupant of
any part of this facility? NO YES
If yes, provide a brief description of the activity or activities performed in the affected area.
SECTION II:
(A) Current address of the facility identified in Section 1(B) of this application and on the Form
“M-46". Please show the complete street address as well as the Assessors Volume, Page,
Map, Block and Lot number for the property.
(B) Former addresses, if applicable, of the business occupant identified in of this application.
(UT-3, PAGE 3)
CT DECD, 450 Columbus Boulevard, Suite 5 | Hartford, CT 06103-1843 | Phone: 860-500-2300
An Affirmative Action/Equal Opportunity Employer an Equal Opportunity Lender
(C) The facility that will be occupied by the business applicant shown in Section I (B) of this
application consist of (Check each that is applicable):
An entire building of approximately
square feet.
A part of a building with a total square footage of
square feet,
of which approximately
square feet will be occupied
by the business identified in Section I(B) of this application.
Construction costs, if applicable:
If project consists of free standing, single occupant facility, what is the acreage?
(D) The facility will undergo/is undergoing new: (check each that applies)
Construction,
Purchase (acquisition),
Expansion,
Renovation (substantial),
Leasing,
and will be used for the following purpose(s): (check all that apply)
manufacturing, processing, or assembly of raw materials, parts or manufactured products;
significant servicing, overhauling or rebuilding of machinery and equipment for industrial
use;
distribution in bulk quantities of manufactured products on other than a retail basis;
research and development activities directly related to a manufacturing process; and/or
other eligible business services. Please ATTACH A SEPARATE SHEET to describe.
(E) Provide a brief discussion of the nature of the use (as indicated in Section II (D), above) that
is to be made of the facility. Include a description of the raw materials utilized, the
manufacturing process and the end product(s), primary market area served sources of labor,
access to major transportation routes and utilities. You may type “Please see attached” and
use additional sheets as necessary, clearly identified as Section II (E).
(F) Provide a brief discussion, as appropriate, of the acquisition, construction, expansion,
renovation, or long term lease of the facility that is expected to occur and which, therefore,
will make the facility eligible for consideration as an eligible facility. Include in the
discussion the size of the facility, the term of the leasing agreement, and the approximate
cost of the construction, expansion, and/or renovation.
(UT-3, PAGE 4)
CT DECD, 450 Columbus Boulevard, Suite 5 | Hartford, CT 06103-1843 | Phone: 860-500-2300
An Affirmative Action/Equal Opportunity Employer an Equal Opportunity Lender
(G) If the facility is being constructed, expanded, and/or substantially renovated, please state the
assessed valuation (prior to and after the expansion or renovation) of the facility, where
to fill the boxes below (A) subtract (B) = (C).
(A)
Enter the estimated value of the property
immediately AFTER property improvement*:
$
Est. completion
date:
Less (B)
Enter the value of the property
immediately BEFORE any improvement*:
$
Valuation
date:
(C)
Estimated change in value:
$
* Please include copies of valuation documents from the Assessor’s Office upon availability.
(H) If the business occupant maintains a website for the business, please provide the web address:
(I) Actual Full-time and Part-time positions (at time of application):
Full-time:
Part-time:
Other:
(J) Actual or Expected dates of:
Acquisition (by lease or purchase) of the facility identified in Section I (A) above:
Occupancy by the business occupant identified in Section I(B) above:
If the facility is being constructed, expanded or renovated, provide a copy of the building
permit for such property improvement(s) and a copy of the Certificate of Occupancy for the
facility.
(K) Estimate the assessed valuation of all machinery and equipment, as well as other eligible
personal property, that will be new to the Grand List of the municipality in which the
facility is located and which is to be installed in connection with the acquisition, construction,
expansion or renovation of the facility:
$
(70% of the total from FORM M-47).
(L) The Department of Economic and Community Development and the Municipality reserve the
right to request information from all certified applicants during the life of the certification.
This information shall include, but may not be limited to:
1. reporting yearly employment levels;
2. the yearly value of the real and personal property tax benefits received; and
3. the yearly value of the corporate tax credit received.
(UT-3, PAGE 5)
CT DECD, 450 Columbus Boulevard, Suite 5 | Hartford, CT 06103-1843 | Phone: 860-500-2300
An Affirmative Action/Equal Opportunity Employer an Equal Opportunity Lender
FAILURE TO RESPOND TO REQUESTS FOR INFORMATION IN A TIMELY MANNER
MAY RESULT IN A LOSS OF BENEFITS UNDER THIS PROGRAM.
REQUIRED ATTACHMENTS & ADDITIONAL INFORMATION for
FORM UT - 3
APPLICATION FOR A “CERTIFICATE OF ELIGIBILITY”
Each applicant for a “Certificate of Eligibility” must provide the following additional information
along with a completed application: (use as a checklist)
To support Section I
A copy of the company’s Connecticut Certificate of Legal Existence (also called Certificate
of Good Standing) – obtained through the Business Recording Division of the CT Office of the
Secretary of State at 860-509-6200, or at
https://www.concord-sots.ct.gov/CONCORD/index.jsp?sotsNav=|&sotsNav_GID=1844
NOTE: The name of business entity on this form MUST MATCH exactly to recorded name at
Secretary of the State’s office. It is the name of the business entity that receives the tax bills
from the local tax assessor.
A brief description of the company, its business, the ownership, and management structure
A brief description of the activities/nature of use to be performed in affected area
List of other EZ-eligible business services to be conducted in the project space/facility
Description of any current or pending litigation in which it is (or is expected to be) a party
Audited or reviewed financial statements for the most recently completed fiscal year
To support Section II
A completed idleness statement (preliminary questionnaire Attachment A), where applicable
A copy of the current valuation from the Assessor’s Office
A copy of the post-project valuation from the Assessor’s Office (if applicable and available)
A copy of the deed to the property, if the facility is being acquired by purchase
A copy of the fully-executed leasing agreement, if the facility is being acquired by lease
If the facility is being constructed, expanded or renovated: a copy of the building permit for
such property improvement(s)
If the facility is being constructed, expanded, and/or renovated: a copy of the Certificate of
Occupancy for the facility
(UT-3, PAGE 6)
CT DECD, 450 Columbus Boulevard, Suite 5 | Hartford, CT 06103-1843 | Phone: 860-500-2300
An Affirmative Action/Equal Opportunity Employer an Equal Opportunity Lender
Other supporting documents to this application
If applicant is attaching additional documents where applicable to provide additional support
to responses in Section I and Section II of this application, please type the title or name of the
document, the date of such document (where applicable), and identify the section and bullet
of this UT-3 application that the supplemental information supports:
(UT-3, PAGE 7)
CT DECD, 450 Columbus Boulevard, Suite 5 | Hartford, CT 06103-1843 | Phone: 860-500-2300
An Affirmative Action/Equal Opportunity Employer an Equal Opportunity Lender
CERTIFICATION BY APPLICANT
OWNER/REPRESENTATIVE, and LESSOR (if applicable)
The undersigned hereby certify that information contained in and attached to this application:
to his/her best knowledge and belief is true, correct, and complete;
that no information is in any way false or misleading, and that no material information has been omitted;
that the municipality identified in this application is hereby authorized now and at any time in the future to
provide to the Connecticut Department of Economic and Community Development (DECD) with any and
all information in connection with matters referred to in this application upon request;
where required by law, may be subject to public disclosure.
The undersigned each represents familiarity with the following provisions of the Connecticut General
Statutes:
• Title 12 – Taxation (https://www.cga.ct.gov/current/pub/title_12.htm)
Chapter 203 – Property Tax Assessment, Section 12-81 – Exemptions:
o Sec. 12-81.(59) Facility in a distressed municipality, targeted investment community, enterprise zone or airport
development zone. Designated manufacturing plant. Service facility;
o Sec. 12-81.(60) Machinery and equipment in a facility in a distressed municipality, targeted investment
community, enterprise zone or airport development zone. Machinery and equipment in a service facility; and
Chapter 208 Corporation Business Tax (https://www.cga.ct.gov/current/pub/chap_208.htm)
o Sec. 12-217e. Tax credits for certain manufacturing, service and eligible facilities. REPEALED eff. 7-1-2018.
• Title 32 – Commerce and Economic and Community Development, Chapter 585 – Enterprise Zones, Entertainment
Districts, Enterprise Corridor Zones and Airport Development Zones at Sections 32-70 et seq., of the Connecticut
General Statutes (https://www.cga.ct.gov/current/pub/chap_585.htm),
• as well as other sections as may be applicable.
Owner/Representative of the facility as identified in Section 1(A):
Print Name:
Title:
Company:
Tel.:
Signature of the Owner/Representative of the facility Date
Owner of machinery and equipment/eligible personal property:
Print Name:
Title:
Company:
Tel.:
Signature of the Owner of machinery and equipment/eligible personal property Date
Lessor of machinery and equipment/eligible personal:
Print Name:
Title:
Company:
Tel.:
Signature of the Lessor of machinery and equipment/eligible personal property Date
(UT-3, PAGE 8)
CT DECD, 450 Columbus Boulevard, Suite 5 | Hartford, CT 06103-1843 | Phone: 860-500-2300
An Affirmative Action/Equal Opportunity Employer an Equal Opportunity Lender
CERTIFICATION BY MUNICIPALITY
OF REVIEW FOR COMPLETENESS OF APPLICATION
FOR A “CERTIFICATE OF ELIGIBILITY”
I,
of the City/Town of
(print name of town officer)
(strike out inapplicable)
(municipality of proposed project)
in my capacity as
,
(official title/position, and name of municipal office)
hereby certify that I have:
__ read the responses contained herein as well as in the attached supporting documents,
__ reviewed the responses and supporting documents with one or more persons listed in Section 1
of this application, and
__ that all appear to be complete in accordance with DECD’s policies and procedures, and
__ that the process and benefits are subject to Public Acts and the Connecticut General Statutes
(https://www.cga.ct.gov/lco/statutes.asp).
for this final application (UT-3) by (name of business taxpayer seeking tax abatements and credits):
Dated this (day) of (month)
,
20
Signature:
Due to COVID-19 pandemic, PLEASE SUBMIT ALL COMMUNICATIONS AND DOCUMENTS TO:
ATTN: Enterprise Zone Program
Connecticut Department of Economic and Community Development (CT DECD)
State DECD Email: DECDenterpiseZone@ct.gov
Dedicated State Enterprise Zone Program telephone number: 1-860-500-2456
For DECD office use only
Received (sender, date, time):
Acknowledged receipt:
Rev. 11/2/2020
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FORM UT - 3: APPLICATION FOR A CERTIFICATE (Naugatuck Valley Council of Governments)

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Completed 28 January 2021

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