Hillsborough County, City of Tampa, and City of Plant City
Economic Development Ad Valorem Tax Exemption Supplemental Application
for Florida Department of Revenue Form 418:
1
.
A
pplicant Name:
2.
Business Name:
M
ailing Address:
C
ity:
Zip:
4. L
ocation of Business (Property address) and folio number(s) for which this Supplemental Application is
filed (attach legal description, survey, and copy of the most recent trim notice for property):
Real Estate Folio #:
Tangible Folio #:
P
hysical Address:
C
ity:
Zip:
3
. List each Principal Executive Officer, director (or any person who performs a similar function regardless
of the Applicant and the Ultimate Parent Company (if applicable), and any person or entity that controls
the applicant. Attach additional sheets, if necessary.
Name
Title or Position
Percent of Ownership,
if greater than 50%
Tel
ephone No.: (
)
F
ax No.: (
)
E
-mail:
5. Select Jurisdiction in which this exemption is applied for:
[
] Hillsborough County
[ ] City of Tampa
[ ] City of Plant City
6. Tr
ade Level (Check as many as apply):
[
] Wholesale [ ] Manufacturing [ ] Professional
[ ] Office [ ] Service [ ] Other
7. D
escribe the Type or Nature of Business; Include North American Industry Classification System
(NAICS). To find a full list, please visit the Census Bureau’s website
.
8. In
dicate number of new full-time employees projected in boxes and provide total
:
U
nincorporated Hillsborough County
City of Tampa
Plant City
Total New Employees
N
umber of employees in Hillsborough County prior to filing application for exemption:
A
verage annual wages paid during calendar year prior to applying for exemption:
$
Note
: Please attach the company’s most recent quarterly RT-6 form. If the numbers from above differ
from the RT-6, please provide a detailed explanation:
9. Ta
x IDs:
a. State Tax ID #:
b. Federal Tax ID #:
0
10. Select one Tier or one Bonus Exemption Tier and one Business Category within the selected Tier:
Business can qualify for one tier only.
Tier 1: Exempting 50% of new value for five years
[ ] Applicant attests that the average annual wage of all new jobs will meet or exceed 115% of the lowest
of the average annual private sector wage of MSA, State or County (currently $48,813), OR in lieu of the
wage requirement, the business will have a capital investment that exceeds $200,000 per job (Attach RT-
6, Federal I-9 and 941 Forms);
OR
Tier 1 Bonus Exemption: Exempting 75% of new value for five years
[ ]
Applicant attests that the project will be located within an officially recognized Enterprise Zone,
Brownfield Area or Community Redevelopment Area and that the average annual wage of all new jobs
will meet or exceed 100% of the lowest of the average annual private sector wage of MSA, State or
County (currently $42,446), (Attach RT-6, Federal I-9 and 941 Forms)
Check the Business Category that applies (Please check only one selection):
[ ] Create at least 10 manufacturing jobs;
OR
[ ] The business must create at least 25 jobs and have a sales factor, as defined by s. 220.15(5) (see
Appendix 2), of less than 0.50 for each year the exemption is claimed for the facility with respect to which
it requests a Property Tax Exemption;
OR
[ ]
At least 50 office jobs with respect to a new business
Tier 2: Exempting 50% of new value for seven years
[ ] Applicant attests that the average annual wage of all new jobs will meet or exceed 115% of the lowest
of the average annual private sector wage of MSA, State or County (currently $48,813), OR in lieu of the
wage requirement, the business will have a capital investment that exceeds $200,000 per job (Attach RT-
6, Federal I-9 and 941 Forms);
OR
Tier 2 Bonus Exemption: Exempting 75% of new value for seven years
(Please check only one selection)
[ ]
Applicant attests that the project will be located within an officially recognized Enterprise Zone,
Brownfield Area or Community Redevelopment Area and that the average annual wage of all new jobs
will meet or exceed 100% of the lowest of the average annual private sector wage of MSA, State or
County (currently $42,446), (Attach RT-6, Federal I-9 and 941 Forms)
Check the applicable qualification below:
[ ] Create at least 30 manufacturing jobs;
OR
[ ] The business must create at least 75 jobs and have a sales factor, as defined by s. 220.15(5) (see
Appendix 2), of less than 0.50 for each year the exemption is claimed for the facility with respect to which
it requests a Property Tax Exemption;
OR
[ ]
At least 100 office jobs with respect to a new business
Tier 3: Exempting 50% of new value for ten years
[ ] Applicant attests that the average annual wage of all new jobs will meet or exceed 150% of the lowest
of the average annual private sector wage of MSA, State or County (currently $63,669), (Attach RT-6,
Federal I-9 and 941 Forms);
OR
Tier 3 Bonus Exemption: Exempting 75% of new value for ten years
[
] Applicant attests that the project will be located within an officially recognized Enterprise Zone,
Brownfield Area or Community Redevelopment Area and that the average annual wage of all new jobs
will meet or exceed 100% of the lowest of the average annual private sector wage of MSA, State or
County (currently $42,446), (Attach RT-6, Federal I-9 and 941 Forms)
Check the applicable qualification below (Please check only one selection):
[ ] Create at least 90 manufacturing jobs;
OR
[ ] The business must create at least 100 jobs and have a sales factor, as defined by s. 220.15(5) (see
Appendix 2), of less than 0.50 for each year the exemption is claimed for the facility with respect to which
it requests a Property Tax Exemption;
OR
[
] At least 200 office jobs with respect to a new business
1
1
. De
scription of the improvements to real property for which this exemption is requested. Th
e
f
ollowing information is requested (Please include any attachments if necessary):
1) type of space, 2) expanding existing buildings or constructing new buildings, 3) square footage of new
improvements (expansions or new buildings, 4) eave height, 5) type of construction (masonry, tilt wall,
steel, etc.),6) roof structure,7) rail siding,8) truck loading docks, and 9) yard materials (concrete, gravel,
etc./what is it replacing?)
12. Description of the tangible personal property for which this exemption is requested:
(Please include tangible personal property information provided on form DOR 405)
O
ffice furniture, office machines, and library
EDP equipment, computers, and word processors
Machinery and manufacturing equipment
Service station and bulk plant equipment (underground tanks, lifts, tools)
Leasehold improvements (grouped by type, year of installation, and description)
Pollution control equipment
Equipment owned by you but rented, leased or held by others
Other, specify:
1
3
. P
rovide the value of the capital investment to be made by the applicant:
a
) Improvements (Building and Permanent Improvements)
$
Square Footage of Improvements
b
)
T
angible Personal Property Improvements (Equipment)
$
1
4.
In
dicate the projected average annual wage of new jobs:
$
1
5.
I
ndicate the extent to which supplies and materials will be sourced within Hillsborough Co.:
1
6
. Des
cribe any environmental impact of the proposed business or operation:
17. Applicant attests that it is not in violation of any federal, state, or local law or regulation, including but
not limited to, environmental matters.
18. All added improvements and all tangible personal property for which an exemption is requested will
not replace existing improvements or tangible personal property.
19
. All improvements will be made and tangible personal property will be added or increased no earlier
than on or after the day the Ordinance specifically granting an exemption is adopted.
I agr
ee to furnish such other reasonable information Hillsborough County, the City of Tampa or the
City of Plant City, may request in regard to the exemption. I hereby certify that the information
contained in this Supplemental Application is true, correct, and complete to the best of my
knowledge and belief.
DATE: _______________________ SIGNED: ___________________________
(Preparer)
Corporate Officer
SI
GNED: ______________________ _____________________________
(Taxpayer) (Preparer)
TI
TLE: ________________________ ______________________________
(Preparer’s Telephone Number)
If (1) the Applicant, the Ultimate Parent Company, or any of its Subsidiaries, (2) any Principal Officer of the
Applicant or the Ultimate Parent Company or (3) any entity that any Principal Executive Officer of the
Applicant or the Ultimate Parent Company controls has been involved in any legal matter, please explain
below:
ECONOMIC DEVELOPMENT DEPARTMENT USE ONLY
Check which applies:
[ ] New Business [ ] Existing Business [ ] Professional
Check where the company is located:
[ ] CRA [ ] Enterprise Zone [ ] Brownfield Area
Total number of employees: _______________ Current hourly wage: $
______________
PROPERTY APPRAISER’S USE ONLY
In accordance with applicable law, and based solely on the Economic Development Ad Valorem Tax
Exemption Program Application Package submitted by ________________, in my capacity as
Hillsborough County Property Appraiser, I hereby submit the following report to the Board of County
Commissioners of Hillsborough County, Florida and/or the City Council of the City of Tampa or the
City Commission of the City of Plant City:
The total revenue available to the County or the applicable Municipality for the current fiscal year
from ad valorem tax sources is:
Hillsborough County: Municipality:
$
$
The revenue lost to the County or the applicable Municipality for the current fiscal year by virtue of
exemptions previously granted under Section (s. 196.1995) Fl. Stat., is:
Hillsborough County: Municipality:
$
$
The estimate of the revenue which would be lost to the County or the applicable Municipality during
the current fiscal year if the exemption applied for were granted had the property for which the
exemption is requested otherwise been subject to taxation is:
Hillsborough County: Municipality:
$
$
The estimated revenue loss to the County or the applicable Municipality for the first fiscal year in
which the exemption is anticipated to be in effect attributable to granting the exemption is:
Hillsborough County: Municipality:
$
$
The property for which an exemption is requested is:
to be incorporated into a new business as defined in s.196.012(15), Fl. Stat. (2010).
to be incorporated into the expansion of an existing business as defined in s.196.012(16), Fl. Stat.
(2010).
not to be incorporated into either a new business as defined in s.196.012(15), Fl. Stat (2010), or
an expansion of an existing business as defined in s.196.012(16), Fl. Stat. (2010).
DATE: ______________________ SIGNED: _____________________
Hillsborough County
Property Appraiser
Signed by:
Chief Deputy Property Appraiser
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