Fillable HENRY COUNTY ENTERPRISE ZONE APPLICATION (County of Henry)

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HENRY COUNTY ENTERPRISE ZONE APPLICATION (County of Henry)

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File type: PDF

U.S.A. forms for County of Henry

BROWSE COUNTY OF HENRY (VA) FORMS

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HENRY COUNTY ENTERPRISE ZONE APPLICATION
GENERAL INFORMATION
(Please type or Print)
Name of Business __________________________________________ NAICS #____________
Facility(ies) EZ, E-911 Structure Address. If more than one location–attach typed list and label
as Exhibit “A.”_________________________________________________________________
Business Mailing Address: Number and Street Name:_________________________________
City, State, Zip Code:____________________________________
Telephone # ________________________________ Fax # ______________________________
Date of construction of original building(s) _______________ If more than one location-attach
typed list and label as Exhibit “B.” Date business established ___________________________
Type of Business: Sole Proprietorship Property Ownership: Lease
(Please Check Box) Corporation (Please Check Box) Own
S Corporation
Partnership
Other (specify) ____________________________________________
Names of Owner(s), Partners, President or CEO _______________________________________
______________________________________________________________________________
Contact person responsible for filing appropriate forms with County and State:_______________
________________________________________________ Telephone #: __________________
E-mail Address: ___________________________________
Company product and/or service:___________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Are any delinquent debts or taxes owed to the County? YES NO
If yes, please itemize: ____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
FIN#__________
Henry County Enterprise Zone Application
Page 2
Incentives: ■ Real Property Tax Grant
■ Machinery & Tools Tax Grant
■ Business Furniture, Fixtures, and Equipment Tax Grant
■ Waiver of Building Permit Fees
■ Waiver of PSA Connection and Facilities Fees
Note:
To qualify for the above stated incentives, this application must be completed in its
entirety.
To apply for either the Henry County Building Permit Fee Waiver or PSA Connection
and Facilities Fee Waiver, the appropriate application form must be completed and submitted
along with the respected department’s application. Failure to submit the appropriate form will
result in forfeiture of the incentive available.
To qualify for the Enterprise Zone Real Property Tax Grant, you must submit a
completed “Real Property Investment Plan/IDA Grant Form.” The Form must be submitted
sixty (60) days prior to start-up of construction, failure to submit form will result in forfeiture of
this incentive.
To qualify for either or both the Enterprise Zone Machinery & Tools or Business
Furniture, Fixtures, & Equipment Tax Grants, you must submit a completed “Machinery & Tools
Investment Plan/IDA Grant Form” or a Business Furniture, Fixtures, & Equipment Investment
Plan/IDA Grant Form.” Failure to submit Forms by March 15th in the year immediately
following the year in which investments were made, will result in forfeiture of this incentive.
Please check appropriate box and provide the following information for Utilities:
Electric Service: Natural Gas:
Service Available? Yes No Service Available? Yes No
Connected? Yes No Connected? Yes No
Need to connect? Yes No Need to Connect? Yes No
How close is supply line?_________Ft. How close is supply line?__________Ft.
Water: Sewer:
PSA water Available? Yes No PSA Sewer Available? Yes No
Connected? Yes No Connected? Yes No
Need to connect? Yes No Need to Connect? Yes No
How close is supply line?__________Ft. How close is supply line?__________Ft.
*If not enough space provided for all locations attach typed list and label as Exhibit “C.”
Henry County Enterprise Zone Application
Page 3
Declarations:
I hereby declare that, to the best of my knowledge and belief, the information contained
in this application is true and accurate and that I am authorized to act on the behalf of the
business. I understand that any refunds or credits to which the business/property owner may be
entitled shall first be used to satisfy any delinquent debts owed to the County. I also understand
that any false or misleading information provided by me or the business may result in the loss of
incentives. I understand that failure to submit required forms and meet required dates will
result in forfeiture of the incentives offered.
I hereby authorize the Henry County Commissioner of the Revenue to disclose to the
Henry County Enterprise Zone Administrator all information regarding the gross receipts or
purchases of the business and/or the amount of machinery and tools owned by the business for
the period that the business is eligible for Enterprise Zone incentives. Further, I authorize the
Enterprise Zone Administrator to disclose this information to the Virginia Department of
Housing and Community Development for reporting purposes. I understand that this
information will not be released to any other person or department.
________________________________________________
Signature
(Corporate Seal)
If Available ________________________________________________
Title
________________________________________________
Date
________________________________________________
Print Name
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HENRY COUNTY ENTERPRISE ZONE APPLICATION (County of Henry)

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Completed 17 July 2020

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