EXHIBIT "B" BOARD OF COUNTY COMMISSIONERS OF PALM BEACH COUNTY ECONOMIC DEVELOPMENT AD VALOREM TAX EXEMPTION PROGRAM ANNUAL REPORT

Transcription

1 EXHBT "B" 2011 RENEWAL BOARD OF COUNTY COMMSSONERS OF PALM BEACH COUNTY ECONOMC DEVELOPMENT AD VALOREM TAX EXEMPTON PROGRAM ANNUAL REPORT FOR EXEMPTON PEROD: January 1, 2.. C) i to December 31, ~6lJ As required by Section 5.1. of the Ad Valorem Tax Exemption Ordinance for this program, this form is to be filed with the Board of County Commissioners no later than March 1 for each year the exemption is in effect and still desired by the business ~ 1. BUSNESS NAME and mailing address: r,;. i.. h: rj jv 2.-5 ~ 't.p ~ r f\ L- t... t'\ o,q..i\ t D,e..~. c-.~ _-.2L bl J.-,u C-a::> ({TtL 1b.t.. f!) S (). i'0 v t.:-l-a-.jj.c: d f L 3 J '10 '1, , 2. Name and telephone number of business owner or person in charge of this business: {'{\ \C-H-A.i..-l- j _ (i i:-c-rrj PS~' ~ 51:?t.J 4.. 5<7 D D "1 ; 3. Exact location ~treet address) of prope for which t~illl report is filed: 2.,... t-- ~'2.3 rf () i L ?.':L]:::.!~Jt.1.-ds r;1,~f(.t1-il?- ~()J. SCi Z" vll~ JL,4c... i l r';)., J ~..i~t~y u beg.~.!:!.e..~siness activities at this facility:..5e.p('?-'pd3 '5. REAL PROPERTY a) Description of the improvements to real property for which this exemption is requested: N A r ' b) Date of commencement of construction of improvements: r A 6. TANGS-CE PERSONAL PROPERTY ' a) Description of the tangible personal property for which this exemption is requested and date when property (p. H ()...chej ) was purchased: Provide this information on the attached form PB-418(6a)fAR, "Tangible Personal Property" Annual Report. b) Average value of inventory on hand as of January 1st: [,' LJ 350 ] '--; Have ;~u maintained the~efinition of a D "New Business" or as an ~Expansionof an Existing Business"? ~es DNo ; 8. Describe the type or nature of your business: i 9. 1) EN J: t:i L,-.:L..""'Ac...:...=B:- Trade level (check as many as apply): D Wholesale D Manufacturing!i'Professional DService D Office D Other ,.....".", JOBS AND AVERAGE ANNUAL SALARY a) Fill out the attached form PB-418(6b)AR, "Jobs And Average Annual Salary" for the appropriate year and provide the following: b) Total number of full-time, equivalent and seasonal employees in Palm Beach County: [ 7 (attach current payroll roster as of January 1 st (covers employee payroll for Jan. 1 s1 through to Dec. 31 s1 of prior year; provide hire dates; omit names and social security numbers of employees) c) Net increase in full-time employment [0 ] and percentage increase since exemption was granted [ D %] d) Average annual salary of employees as of January 1 sl payroll roster with executive positions.. 2f.e..ooc> e) Average annual salary of employees as of January 1 s1 payroll roster without executive positions1l 3 <0, Co ). 0::Y- : 11, TOTAL SALES Sales factor for the facility requesting exemption: Total sales in Palm Beach County ending December 31 sl of prior year from this facility [, 52. q 0(;>0 ] Divided by total sales everywhere from this facility.;. [ ] equals [ - % ] ::nz. t-\ Percentage increase in productive output resulting from this expansion since year exemption was granted [ % ] ~ ' For office or facility space owned or leased and used by a corporation newly domiciled in Florida: rj A i a) Date of incorporation in Florida: b) Number of full-time employees at the time of application: [ 1 and currently at this location: [ ].,. i agree to furnish such other reasonable information as the Board of County Commissioners may request in regard to the exemption. hereby certify that the information and valuation staied above by me is true, correct, and complete to the best of my knowledge and belief. (f prepared by someone other than the taxpayer, hisher declaration is based on all information of which he has any knowledge.),

2 PB 418 (G.a.) AR EXHBT "B" - ANNUAL REPORT (continued) TANGBLE PERSONAL PROPERTY 6.a. Description 0 f t h e tanqib e personal property for w h' C h this exemption is ree uested and date when property was purchased. CLASS OR TEM AGE DATE OF PURCHASE ORGNAL COST DESKS ANu 5 t-! E" L V N.Cx '=t- ZOOLJ til 4,T-OO fb'd~e" S'lSlEMS 1\ ODTL E~u.i prnt;nt l{..:>.515 C-PtB\NCTS <6 :2.DO 3 ro3,500 A LA ~ 1"\ ' STE" f"\ S ZoD3 'i DEL L e.o (Yl ~L.U cc:z S\.j 5'TErr LJ c.o \(\ f( \J..\"eiZ E:Qu.~fcnEN\ (0 : :" (.302-8'". 13C:, 4-,8~5 LAflTDP m:fh 5 200Ca Z.1Jo9 DCNTAL c Q L.L '\ of' (Ytc \J "\ \1 qq4 1> z. ~z-:r -:r VOCLo'R EQu~f cnt;0"t 1"1 \Q'44 '1,.511 DeNAL equ:e'rne-c0t \'6 \~q3 z, '1(:,9 LAB EQu~ frne Vl 1 wolf y-, loy. Lf\6 cqu\ P\"y\.e;-t0l' l 1.ool.\ ~ \. SSy. LR-B EQui P('(.ENT l 20 0 Lt LAe:, CQL..l.-:frn.ErU(" ~ 2005 LAe, EQ \.J...\ ~ me NT 5> t. A.59 ::P,OlGj 10 -; :; \,050 medtc..f\l. tqw~('2m \ODO G A p TAXPAYER'S ESTMATE OF 0 G 0 FAR MARKET VALUE D R V.,.,,, v,, v" G:\EDO';l -').; EXEfY!PTON'.2((jf~ Annual F~eport T 8:: E}:ernptiQ!l.doc

3 PB"418 (G.a.) AR EXHBT "B" - ANNUAL REPORT (continued) TANGBLE PERSONAL PROPERTY 6.a. D escnptlon of the tanoible personal property for which this exemption is ret uested and date when property was purchased. CLASS OR TEM AGE DATE OF PURCHASE ORGNAL COST G A p TAXPAYER'S ESTMATE OF 0 G 0 FAR MARKET VALUE 0 R Mcb"\ C-A L EQ ui r(r\ ~ Li ZOCR- EP G50 ', EQu;,p mt::::f\.)(' t. \5C) v 6Qu;f> C(\C-M 4 '2001 5; l. 3C19 v E- Q LA. ~ f (1\crOT \5 l~q6 Si 156 i.... SUC'TOt0 (Y\ fi. C- t- \ (\.) C CZS 1.'D'D~ <: 5,5:2.0 A- d;z e..o~f! (2.t;.sso R 8" 2003 <6,30 3 v f\-\e. CD f\.y\:::;. \:" ~ Ql\J \ t'j6 lj.. f\..:ht -=l- '2004 '.,. 2.4'15 M-oOD :::r \ (j:;, 2.-'15 K-oDb fa ZooS G-f\s LNEs G '2-0 os ~ \,84\ v L~A SE-t\- OLb - C-Qv...0\tS-P-s L-\ 2oo"f goo v ~f\-;;,c \-to L.u,- c:..ou...n\c~s 4 LDD ' &'au v L-SR- st-tk) lb - CDu...t0 \ \;;- R So 4 '2001 'lp L 539 V- LFAse: tiocd- LO~~:s. 4 7-cJOi ' ql-:? L2Ft SE t\dlj).- (.f)l)...j\.)lc-g2...s 4-2.oDt-. ~o'l v ('J6w :>Ac..~ DcoR. 3 2-oo g- tt> -yog- ;' Z-"lO.,. (.;:\1:: DO\ p,'j.: EXEfl;iPTON,:2UU6 Annual Report Tax EX6rnptin!l.doc

4 PB 418 (S.a.) AR EXHBT "B" - ANNUAL REPORT (continued) TANGBLE PERSONAL PROPERTY, 6.a. Description of the tanoible personal property for which this exemption is ret uested and date when property was purchased. CLASS OR TEM AGE DATE OF PURCHASE ORGNAL COST G A p TAXPAYER'S ESTMATE OF FAR MARKET VALUE 0 G 0 D R LEASEMclD \(Y\ fr QvE me-nt q 2oo~ ~ 'i!?g 1 0D0 L &t\\ F'l'j..-l ures ~ r OFFicE CDUJ'J TB f\ TO P! ~ F l... f rae~' (\J E-TS 2.Dl D LfT6 'F::ou; P mef0t 2.OW < ; 0(000 " ;;{,.542 c::'o 1 L+ q(p. 2-4, ceo 00 LAB r~ ( 1 i P(Yle!0, \j5 800'0 0 Lfr6 EO LA-~ f> me-t0t 2.01 D G) L r;]jq.b, LA~ EQu'\ f> MEM \ 20(0 1,f?lq'b1 Qo m r v--\'e~ EQ u. '\ ~ (Ol.e-rJ-T \ 2..0 L i) f ;:< 55 ()::) Mil-LiN0- ML'\c.t+il\1e' Q, ODD ' v v...- '.. G"\EO()\l'p,.>: EXEfv1PTON'200R Annual Repori. Tax Exemption.rioc

5 PB-418 {G.b.} AR EXHBT "B" - ANNUAL REPORT (continued) JOBS AND AVERAGE ANNUAL SALARY 6.b. dentification of the annual status of Total Jobs and Avera!1e Annual s alary as of January 1 st ( PA-R..T li'ryle) Exemp- Year FULL-TME JOBS EQUVALENT JOBS SEASONAL JOBS TOTAL JOBS tion Period (2,080 Hours) Total Avg. Annual Salary Total Avg. Annual Salary Total Avg. Annual Salary Total Avg. Annual Salary Existing Jobs: Applic. J{o 3S', 21 {P Z 17, 9q 4- g 3Co ozl New Jobs Obligation 1.. -_.. _--_ ~ _ NSTRUCTONS: dentify the Full-Time Jobs above. f there are no Equivalent Jobs or no Seasonal Jobs enter non-applicable (NA). These job figures are restricted to the company's facility or facilities that are located in Palm Beach County. Refer to tem # 10 on the Annual Report concerning additional job and salary data requirements.

6 EXHBT "B" - ANNUAL REPORT (continued) NOTARZATON OF ANNUAL REPORT ~ _._--- _._ ,. The information provided in the Annual Report is accurate and complete for the business facility identified hereinabove.. NOTARY ",'Ufr", ~"~t!!v.. ~~ A. MCLAUGHLN ~ g.~. Notary Public - State 01 Florida ~ \~~~ My Comm. Expires Dct5, 2014 ~ ':E,PFf~~.",, Commission EE '... ' l.. PROPERTY APPRASER'S USE ONLY._---_ Estimate of the revenue which will be lost to the County during the current fiscal year had the exempt property otherwise been subject to taxation:.._--_... _--..-_..,-. -_._---.."._-..._,. Estimate of the taxable value lost to the County: [ _ _ _-._--_.,.-..._-._--_....._ _..._ _-._ _-..._ _..,.._..._-_...-_ _J.,. ~.~.<!~_al!:'r:9..e~_r!y~.. Lt..._ L.._._._..._. ; '.._... _~.~r.9.y_~mefl.~~~_~~.~lp.!.cp.~_~~jl_....._ DATE SGNATURE (Property Appraiser).! i

7 L... _.. (lj~r ECONOMC DEVELOPMENT AD VALOREM PROPERTY TAX EXEMPTON Chapter , Florida Statutes DR-418 R 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. 1 Business name ~ESS,)avrtL J..-.AB +NC- Mailin~ address J t s 2 Please give name and telephone number of owner or person in charge of this business. 7j{'L ~~~ ~'j7;i,4t1-f 3~;,y' Name ',-,\ \ Qt-lnGL \-h;:"'jv'f'e.s,.y1 ~(O - fs'flf-<;:'10 Telephone number S-"-'g'1";- SlOG 41~ate you began, or will? 3 Exact Location (Legal Description and Street Addres~of Property for which this return is filed <)70( (N Te(l..5~.p~t- (u>a...).s: ) \'\i(..a..lt-(],..f--li+ r, 5 Describion of the improvements to real property for which this exemption is requested -ef"i"a L.. L...~ MAN d rac {ljlv.je:, FA-'_. r..f (j) begin, business at this facility ~ l-oo.-? Date of commencement of construction of improvements of ) Description of the tangible personal property for which this exemption is requested and date when property was, or is to be purchased APPRASER'S USE ONLY Date of Taxpayer's Estimate of Class or tem Age Purchase Original Cost Cond" Fair Market Rent Cond" 5EE.~J hd, Average value of inventory on hand: 41 WD "Condition: good, avg (average), or poor Any additional personal property not listed 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 D new business or ~ expansion of an existing busine~ 9 Trade levels (check as many as apply) 8 Describe type or nature of your business t o Retail 0 Wholesale ~nufacturing 0 Professional!vA N J FA; L-TV 1!:> e ~ \. c).s "i""'fh:;:. c~ ~rvice D Office DOther, specify: 10 Number of full-time employees to be employed in Florida 1:'2., f an expansion of an existing business: ~e~~:;:nt - 11 Sales factor for the facility requesting exemption: Total sales in Florida from this facility-one (1) location only " lto.5s-7 % ~ncrease in productive output o resulting from this expansion divided Total sales everywhere from this '. --7 by facility-one (1) location only }5~ fs. = lcjcj % 12 For office space owned and used by a pate of incorporation, ~ Number of full-time corporation newly domiciled in Florida in Florida i D tt ( 99 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 , Florida Statutes. agree to furnish 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. (f prepared by someone other than the taxpayer, his detion is based on all information of which he has any knowledge.).. JJ Date 7. ZA! l~.'i Signature, prepare~ f.j( f L 1, ~) ' P r' dd6:~3~ La-i.lMAM!Y-ilft'i,s,-,,.n;O\ '11{;fVt f5i;..,.e, FL 53 Yo).~~-~ "<1 repare s a ess f1 ~ {.1 Si n ~,taxpayer,..,-- _ Titlel r~tf1 Preparer's telephone number C;-6(-,~~. L2-~1-- \. Property Appraiser's Use Only Total revenue available 1o-ttre' county or municipality for the current fiscal year from ad valorem tax sources Revenue lost to the county or municipality for the current fiscal year by virtue of exemptions previously granted under this section 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 V Estimate of the taxable value lost to the county or municipality if the exemption applied for was granted mprovements to real property Personal property V have determined that the property listed above meets the definition, as defined by Section (15) or (16), Florida Statutes, as a Dnew business Dexpansion of an existing business Dneither V Last year for which exemption may be applied % Application to be filed not later than March 1 Date Signature, Property Appraiser

8 PB-418 (6.a. ) far EXHBT "B" ANNUAL REPORT (continued) TANGBLE PERSONAL PROPERTY 6.a. Description of the tanqible personal property for which this exemption is re uesled and date when property was purchased. CLASS OR TEM AGE DATE OF PURCHASE ORGNAL COST DESK.:!> AND 5t-1E'LV;N.& 1- ZODW q; 4. 'TOO Pr\O 't0c S'S'TEMS AD[)TL E(:;lu.;pmFNT 1- zo04 t.),515 C.P,e,i NeTS <is' :z..d03 fo3,500 fi LA j:( N\ S'l5'TE: M S' ZoD3 7.3(,,2- DE LL <:0 cy\flu t:(2,. S'S'TErn Zoo Lj a- g-,13c:, <:010\ (' \..l'fer. EQu..; t' (n E N f.a 4,8"5 LA{)TDP m'j"h 5 20D(., ~ Z,1..(,,9 DeNTAL [; Q LL ~f moo!\) T \1 qqy 1> Z, {pz"i- '"'VoCLoR CQU.; f N\t;t0'T \q~y ' '1.511 o CN'TAL t;qll; erner0't \ ~ qq3 iii LP.B EQu.; erne r0! "1 wolf ' '-to 'loy LP,S EQ Le P(Y'\.Ft01 l l.odl\ :f \,554 U:\-B EQu, P['(\EN{ '2.00 Lt s., J5~ LAe, CO u.; frn'e rsr ~ 200S' ~.O"~ LPre, EQ u..i f (lie r0t ro :wo5 s l. 050 'Y\cDie,f... isq u.t r("")e M q 2 01 ~ 4,ODO G A p TAXPAYER'S ESTMATE OF 0 FAR MARKET VALUE G 0 0 R V v.,, v, 1

9 PB-418 (6.a.) AR EXHBT "B" - ANNUAL REPORT (continued) TANGBLE PERSONAL PROPERTY 6.a. Description of the tangible personal property for which this exemption is re uested and date when property was Durchased. ClASS OR TEM AGE DATE OF PURCHASE ORGNAl COST lep. SE t\ cti) \(Y\ fr OV rnftv't q 2.002> W 'S"Cc.,00L) Ll c:r\-'c't Fl'1-TuRes ~ '2.-DO?'! DFFlcE CDLU\l T5 f2. TOP FLE. cyi6inets 2,OD ute f?;qui P met0t - ~ G:.,oDO d,..542 &0 4'1(0''')..4 WlD <,ceo oo LAB 2Q u i p(y181\.:n Z.010 :p god Dc.) Ul-B EQu.:" N1SNT G> L ~Cj 61 LA~ EQu'\ P mer0t \ 2.Dlo! 1,f?g'bleo rn P v...tcf?- EQ LL',?cn8-,,-,"' \ 2-0 Lv P.;;{55 CD (Vti l..lincr MAc.t+iNe :> [lci, DOD G A p TAXPAYER'S ESTMATE OF 0 G FAR MARKET VALUE 0 D R v' v V" ' G \EDO\P.~; EXEMPTGN'2U:Jn Annua! Re~-Drt Ti?~ Ey.smptiQ!.doc