Okaloosa County BOCC — January 18, 2013 — Exhibit D - Form DR-418 — reading text

Exhibit D ECONOMIC DEVELOPMENT AD VALOREM PROPERTY TAX EXEMPTION OR 418 Chapter 196.1995, Florida Statutes To be filed with the Board of County Commissioners, the governing boards of the municipality, or both, no later than March 1 of the year the exemption is desired to take effect. R. 12/99 4|Business name Project Machine |Mailing address Confidential at this time 2 |Please give name and telephone number of owner or person in charge of this business. HOLT, FL 32564 Name Confidential at this time Telephone number 3|Exact Location (Legal Description and Street Address) of Property for which this retum is filed 4 Date you began, or will 41114994 $1/2 OF SE1/4 S OF I-10 LESS SOLD BK 2774 PG 993 begin, business at this facility 5 |Description of the improvements to real property for which this exemption is requested Date of commencement of 90 DAYS SEE ATTACHED construction of improvements AS 6 Description of the tangible personal property for which this exemption is requested and date when property was, or is to be purchased} APPRAISER'S USE ONLY Date of Taxpayer's Estimate of Class or Item Age | Purchase] Orginal Cost__| Cond* Fair Market Rent | Cond” IMANUFACTURING EQUIPMENT NEW |* $ 744,362 > S SEE ATTACHED $ $ $ $ > $ OTHER EQUPMENT NEW |* $ 125,000 $ $ (COMPUTERS AND FURNITURE) $ S$ S $ $ 3 *90 DAYS AFTER RECEIP OF GRANT FUNDS $ 3 $ $ $ $ $ $ $ Average value of inventory on hand: $450,000 "Condition: good, avg (average), or poor Any additional personal property not listed above for which an exemption is claimed must be retumed on form DR-405 (Tangible Personal Property Tax Return) and a copy attached to this form. 7 Do you desire exemption as a[__] new business or | 7 | expansion of an existing business 9 Trade levels (check as many as apply) 8 Describe type or nature of your business [_] Retail ([]Wholesale [¥]Manufactunng [_] Professional MANUFACTURE SAWMILL MACHINERY USED TO MANUFACTURE BOARDS {| Service C] Office [_} Other, specify: 10 Number of full-time employees to be employed in Florida J eon - _|Net increase Increase in productive output if an expansion of an existing business:);- 4 ' 15 75 % resulting from this expansion 85 % 41 Sales factor for the facility requesting exemption: Total sales in Florida from this divided |Total sales everywhere from this rf facility-one (1) location only cag ke by | facility-one (1) location only FOG 514 = 115 % 12 For office space owned and used by a_ /Date of incorporation 4994 DE CORP Number of full-time 48 corporation newly domiciled in Florida _|in Florida employees at this location | hereby request the adoption of an ordinance granting an exemption from ad valorem taxation on the above property pursuant to Section 196.1995, Florida Statutes. | agree to fumish such other reasonable information as the Board of County Commissioners, the governing authority of the municipality, or the Property Appraiser may request in regard to the exemption requested herein. | hereby certify that the information and valuation stated above by me is true, correct, and complete to the best of my knowledge and belief. (If prepared by someone other than the taxpayer, his declaration is based on all information of which he has any knowledge.) Date 11/08/2012 Signature, preparer = A 7 SF P. ers add Signature, taxpayer Confidential at this time linea Title | PRESIDENT Confidential at this time CS Preparer’s telephone number Property Appraiser’s Use Only | Total revenue available to the county or municipality for the current fiscal year from ad valorem tax sources $ —- il |Revenue lost to the county or municipality for the current fiscal year by virtue of exemptions previously granted under this section |$ O- iil Estimate of the revenue which would be lost to the county or municipality during the current fiscal year if the exemption applied $ for were granted and the property for which the exemption is requested would otherwise have been subject to taxation —- iV |Estimate of the taxable value lost to the county or municipality if the exemption applied for was granted m improvements to real property $ ~(G- Personal property $9. OOO (Arc aHachea & XK Ai bit a) V_ |i have determined that the property listed above meets the definition, as defined by Section 196.012(15) or (16), Florida Statutes, as a [_ ]new business éxpansion of an existing business —_[_]neither Vi |Last year for which exemption may be applied lal a) ! Ig | or Pn “a ee lZ-32- er Zee Z Aa en Application to be filed not later than March 1 flea Ee Signatur’, Property Appraise? > —