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Chapter 196. 1995, Florida Statutes R. 12/99
To be filed with the Board of County Commissioners, the governing boards of the munldpallly, orboth,
no later then March 1 of the year the exemption Is slashed to lake affect.
1 Business name Project PPE Matiing address Confidential
2 Please give name and Ielephow number of owmsf orpelwn in charge orris bltslnass.
Nalne
Confidential ITelephons, number
3 Fxad Location (Legal Description and Street Address) of Property for which this return Is filed 4 Date yov began, a wlll
161 HUI Ave Ft Walton Beach Florida
begin, lushness attheraaryy 811/ 2O2D
5 Description of the Improvements to real property for which this exemption Is requested Date of commencementd
Extrusion line, Air compressors, support system 811/ 2020
construction aflmprovements
6 Description of the tangible personal property for which this exemption Is requested and data when prope was, or Is to be purchased
Date of Taxpayer' s Estimate of ;.' t
Class or Item t -•5
a Purchase Ori9lnal Cost Cond' Fair Market Rent 100 -
Extrusion line 2 yr 8/ 16/ 202 $ 350000 good 350000
Air compressors used 8115M02,,$ 50000 good $ 50000
Auxflary Equipment new 8/ 1512D2- $ 150000 good $ 150000 $
Electrical Work new 8/ 161202 $ 50000 good $ 50000
Mold new 8115/202 $ 150000 good $ 150000
1$
Average value of Inventory on hand: • CondiUon: good, avg ( average), or poor
Any additional personal property not fisted above for which an exemption is claimed must be returned on form
DR -405 (Tangible Personal Property Tax Return) and a copy attached to this form.
7 Do you desire exemption as a [ a new business or expansion ofan existing busines 9 Trade levels (check as many as apply)
8 Describe type or nature of your business[]
Retell El Wholesale R Manufachrirg Professional
Manufacture of PPE materiels
v Service 2 Office Other, specify;
10 Number of full-time employees to be employed In Florida
fan expansion of an existing business: InNetemployment
Increase Increase In productive output
a0
resulting from this expansion
11 Sates factor for the facility requesting exemption:
Tole/ soles In dMded
facilityoma (i) location
from INa 2,6(10 000
location only Tata/ sales everywhere hom this 7 600,000 10, 000,000 %
by faclihy-one ( 1) Iocatlon Only
12 For office space cubed and used by a Date of incorporatlan Number of full -Uma
6/ 10! 2020
corporation newly domldled In Florida In Florida employees at this location 50
I hereby request the adoption of an ordinance granting an exemption from ad valorem taxation on the above property pursuant to Sedlon 198.1095, Florida
Statute& I agree to furnish such other reasonable Information as the Board of Courtly Commisslonars, the goveming authority of the munldperty, or the
Property Appraiser may request in regard to the exemption requested herein. I hereby certify that the Information and valuation stated above by me Is true,
torted, and complete to the best of my knowledge and bellal. (if prepared by someone other then floe taxpayer, his declaration Is based on all Information of
which he has any knowledge.)
Date 7/ 2012020 Signature, preparer
Puaparer' s address
Signsture, iexpayer C.. rc. N , A/^ / Q/ p
Title Confidential at this time. Preparers telophona number
3 "{. v' t` . ' # '-`:. ' t :: 3 . IRaoa, -` 3`".p ....! tY.APP$ li r lllr >p..,Y${k k gial..Pr, Z; 4•rP,c" tr+ ii'`+
t'{.'
s , '; y4̀" L<i. ".. z ":^ St:
I Total revenue avalleble to the county or municipality for the current fiscal year from ad valorem tax sources $
It Revenue lost to the county or munldpallly for the current fiscal year by virtue, of exemptions previously granted under this section $
III Estimate of the revenue which would be lost to the county or municipality during the current Oscal year if the exemption applied
for were granted and the property for which the exemption Is requested would otherwise have been subject fo taxation $
IV Estimate of the taxable value lost to the county or munldpsilty If the exemption applied for was granted
Improvements to real property S Personal property $<
V I have determined that the property listed above meets the definition, as defined by section 196.012( 1 or (18 , Fiodda Statutes, as a
w business expanslon of an existing businoss neither
VI Last year for which exemption maybe applied
Application to be flied not later than March 1 O a
Da c-.
ne,
alurProperty Appraiser
Economic Development Ad Valorem Tax Exemption Supplemental Application
NOTICE: This supplement application is to be used by the Applicant to provide additional information for review by the governing bodies in Okaloosa County
and the entities involved with the process. The Department of Revenue DR -418 form must accompany this application for formal review by the Okaloosa
County Property Appraiser' s office. Access the DR -418 at http:// dor. mvforida. com/ dor/property/forms/ current/dr4l8. i) df
A. Legal name of the Applicant: Confidential at this time
B. Confidentiality Request in place: Yes ® No
If yes, project name? Project PPE
C. Business Address:
City State/ Province Zip Code
D. Type of Business Manufacturer of Personal Protective Equipment
A. Which of the following best describes the Applicant:
New business to Florida Existing Florida business creating and/ or retaining jobs
B. What is the decision making timeframe of the Project? August 2020
C. Please provide the address of the proposed permanent location of the project: 161 Hill Avenue
City Fort Walton Beach State/ Province FL Zip Code 32548
D. Within city or town limits? Yes ® No If yes, which city/ town? Fort Walton Beach
E. Number of existing full- time employees? Average wage of existing employees?
A. How many, new to Okaloosa, Full -Time Equivalent Jobs are projected to be created as part of 50
this Project?
B. What is the projected annualized average wage ( excluding benefits) of the new Full -Time
Equivalent jobs created as part of this Project? $ 49, 000
C. What is the projected annualized average cost to the Applicant of benefits for each new job
created as part of this Project? $ 4, 000/job
Provide the job creation schedule to which you commit. If your job creation schedule extends past 3 years, please feelfree to
add additional rows.
Phase Number of net new full-time equivalent jobs created Date by which jobs will be created
1 25 12/ 31/ 2020
II 25 12/ 31/ 2021
111 12/ 31/
IV 12/ 31/
Total 50
A. Describe the capital investment in connection with the Project in real and personal property ( Examples: construction of new
facility;
