EXHIBIT "B" BOARD OF COUNTY COMMISSIONERS OF PALM BEACH COU NTY ECONOMIC DEVELOPMENT AD VALOREM TAX EXEMPTION PROGRAM ANNUAL REPORT
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1 EXHBT "B" BOARD OF COUNTY COMMSSONERS OF PALM BEACH COU NTY ECONOMC DEVELOPMENT AD VALOREM TAX EXEMPTON PROGRAM ANNUAL REPORT FOR EXEM PTON PEROD: January 1, /:) () to December 31, /)..() J / 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: KM-8avf:ARD ~. LU!..- q8de ~fjfr.ess UtN~ ;3&- 2. Nam~Anslte l ephone number oj. buslne ~ s owner or person n charge of t~)4l slness: f'/l OKlfrfl/ p. l:!>f-sl;2l3' 5~/-~'f' - _"2'80 : 3. Exact 10cati.9Jl (street address) of property for which this report is filed : '::)A-m 4. Date you began business activities at this facility: /.;J -J.6-/:)3! 5. REAL PROPERTY a) Descripti on of the improvements to real property for which this exemption is requested: + (!f)tl.brf(.u(!;f{)n c;p AN () FP'let:- PR..()eESS/'N~ pla-n pl2e-~otllyg- rf/tul7tj b) Date of commencement of construction of improvements:.;::;:- "-::::l. C-J -!5 - ~O ~..::;? 6. TANGBLE PERSONAL PROPERTY a) Description of the tangible personal property for which this exemption is requested and date when property was pu rchased: Provide this information on the attached form PB-418(6a)/AR, "Tangible Personal Property" Annual Report. b) Average value of inventory on hand as of January 1st: [$ f7q 000 ] 7. Have you maintained the definition of a ~w Business" or as an 0 "Expansion of an Existing Business"? ~s ONo. 8. Describe the type or nature of your business:. PRo {t 55 N Ur, Pl2e-C/JtJ tin&- of 6f1PP--Nb- Or /2e6>ttVe~.Bt. -::::::' 9. Trade level (check as many as appl ~) :.. ~~le ~~le... g!"! a~ u.!~.~.t_~ ~_~ _ g~r~~~.~~o_~ g~~_~~e g_ <?f!i~~ g_ 9.t~~~. ~ 10. 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: [ b 1 ]. " (attach current payroll roster as of January 1 st (covers employee payroll for Jan. 1 st through to Dec. 31 st of prior year; provide hire dates; omit names and social security numbers of employees) c) Net increase in full-time employment [ ] and percentage increase since exemptioj},. was granted [ % ] d) Average annual salary of employees as of January 1 st payroll roster with executive positions.1f 7:) 5t)t') e) Average annual salary of employees as of January 1 st payroll roster without executive positions# / ~ :Jl CJ.._...._ "_.-_." _ "'-"-'-_.'--'-'-'--"-"-'--"-"-...--_._._..._..._.._-_..._._-_._._....._ _... -_..._ : 11. TOTAL SALES... _._--_. _ Sales factor for the facility requesting exemption: Total sales in Palm Beach County ending December 31 st of prior year from thi,s facility [$ 8 3(PQJ 54 3 Divided by total sales everywhere from this facility + [$ ~ 8) 7 {q tfltj ] equals [ s. %] Percentage increase in productive output resulting from this expansi6n since year exemption was granted [ 7 %]... _._._-.. _..._.._ : 12. For office or facility space owned or leased and used bj:..a corporation newly domiciled in Florida: a) Date of incorporation in Florida: b -~~ -{) ~ b) Number of full-time employees at the time of application: [ () ] and currently at this location: [ / h 7 ] 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 stated above by me is true, correct, and complete to the best of my knovvledge and belief. (f prepared by someone other than the taxpayer, his/her declaration is based on all information of which he has any knowledge.) Taxpayer Name & Title: G:\EDOTAX EXEMPTON\200G Annual Report Tax Exemption.doc
2 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 ~~~~Y:~t.~<. REN~ J<? CREWS =.: -~.: Commission # EE ",r,-, ~ -= Expires November 1, 2014,,' BondedThru Troy Fain nsurancell()(hl 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:.----l- r PersQ.n_~J.9.!~~.~L.L~.... L.._ :, SGNATURE (Property Appraiser) G:EDO\T AX EXEMPTON\2006 Annual Report Tax Exemption.doc
3 PB 418 (G.b.) AR EXHBT "B/' - ANNUAL REPORT (continued) JOBS AND AVERAGE ANNUAL SALARY Economic Development Ad Valorem Tax Exemption 6.b. d entification of the annual status of Total Jobs and Average A nnua S a ary as of January l S. Exemp lion Period Year ;J.b//) FULL- TME JOBS EQUVALENT JOBS SEASONAL JOBS (2,080 Hours) Total Avg. Annual Salary Total Avg. Annual Salary Total Avg. Annual Salary Existing Jobs: Applic....1 _- Jt/?$/j,JJ...l~~. ~~/Jw ~ New Jobs Obligation 1 -- _... _- _... _._--_... _ Total _- TOTAL JOBS Avg. Annual Salary G NSTRUCTONS: dentify the Full-Time Jobs above. f there are no Equivalent Jobs or no Seasonal Jobs enter non-applicable (N/A). 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 conceming additional job and salary data requirements. G;\EDOTAX EXEr,PTON2006 Annual Report Tax Exemplion.rioc
4 PB-418 (G,a, ) AR EXHBT "B" - ANNUAL REPORT (continued) TANGBLE PERSONAL PROPERTY Economic Development Ad Valorem Tax Exemption 6,a, DeSCription 0 f t h e tanql 'bl e~ersona property or w h' C h t h' S exemption S ree ueste d an d d ate w h en property was purc h ase d, CLASS OR TEM AGE DATE OF PURCHASE ORGNAL COST G f{)rlt!. 1../ f'i 7 j -5 -() t.j. E~ bq{) e- ro/4(lf ~tf 3bJ ~ q () o!:- Fo/ZKL/f/ 7 L -8-fJ1 EiJ b q D [)!d- Fo/zKLF 1 f ~5-{)rf _~!;; hq{) ~ Fo/2i<LFi 1 ~ 5-()f 6? ~ 3'66!!E- Vt&k1Yl TUte" 7 /;) ~/Et)J f) 00 ~ / f, A p TAXPAYER'S ESTMATE OF v 0 FAR MARKET VALUE G 0 R v' g 5tJD f).!!-./ g l)t) ~.!-,/ & ()1J e v" todf) }}::-,v bo~{)~ d2!j ()() () ~ G:\EDOTAX EXEfvlPTON2006 Annual Roporl Tax Exemption.doc
5 TKM FARMS, NC. - CYPRESS COOLNG, LLC PAYROLL ROSTER AS OF JANUARY 1,2011 EMP # HRE HRE EMP DATE DATE # DATE 1 2/24/20114:52 PMC:\Users\rj\Desktop\Economic Dev Board Economic Dev Board
6 TKM FARMS, NC. - CYPRESS COOLNG, LLC PAYROLL ROSTER AS OF JANUARY 1, 2011 EMP # HRE EMP HRE HRE DATE # DATE DATE
7 To be filed with th~ Board of County Commissio 1. Econor' )evelopment Ad Valorem Proper' H:tX Exemption Chapter , Florida Statute_ DR-418 R. 12/ RENEWAL Name -4~~~wl ]~~ ~~:L~~~~~ ~~~~~~~ TelephoneNumber :5f+-m E 5hl-Q4' -lqgo Exact Location (Legal Description and Street Address) of prop:;;~ which ~s return is filed' Date you began, or will begin, business at this facility:----j.!.~:...l~l..!o<!!...:..l----7r:;:_;,7_;:;:~.,._;: ::_~:_: :_J-- ::_,...---_;;;;:r;::;:-=-;;;:""----7'i>77v"2e:;... ~.ss?z,../-;-;n &- 5. a. Description of the improv ofb. Date of commencement of construction of improvements:,!",~.lc... L ~c..._'~ a, Description of the tangible personal property for which this exemption is requested and date when property was, or S to e pure ase : b. CLASS OR TEM AGE f1) (!J(L F 1 r;{)/z..j(.lj FE '! Fo k...1<l.{ FT '! r:-=6f2.kf-. pr '1 --Di<-KLl FT '7 V MLlJLM ln/be ), Average Value of inventory on hand: 1fLj-75. Of} 0 DATE OF PURCHASED ORGNAL COST ) -5-f) f/ ~~ ttfd L -5-{)'/- ~,,/16 /-1=)-0 ff' :3~, ;'f{; 1-5-litf 3~/6~O --.F5 -() Cf,Q::J' E ~-'5 j,;)16'/)3 Lf.5D J}(){) TAXPAYER'S TAXPAYER'S c ESTMATE OF E APPRASER'S Condition ESTMATE OF '5 "8 FAR MARKET c USE ONLY 8 0 iil ~ a. VALUE ()./ f>6t;"d./ J:;p() ~'() V v" BJD V /d:)(j'() V 1.9"'57) Of) [) 7. 6, Manufacturing 0 Service 0 Office 0 Other 0 lqa~_~~~~~~~ ~~-~------~lj~~1~ b. f an expansion of an existing business: (1) Net increase in employment or' % (2) ncrease in productive output resulting from this expansion -,- % 11. Sales factor for the facility requesting exemption: 7 ~ 'd., q 1\ ~ Total sales in Florida from this facility-one (1) location only !...i-,...'-:::::-~...,;_r_--.,;_k;.._,"7"7'\;--'-::;;{/r_~-r_l... f)'r&r =_ divided by 12. Total sales everywhere from this facility-one (1) location only 7 B. 'il q,j; q 9' :: ;.,;::>=-'--17' % 7 ) 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, orthe 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 declaration is based on all information of which he has any knowledge.) {) ~d DATE: ~~----~= SGNED: ~:: --~-- (Preparer) (Pre parer's Address) Property Appraiser's Use Only (Pre parer's Telephone Number) Total revenue available to the county or municipality for the current fiscal year from ad valorem tax sources:., V. 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: 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 New Business 0, an "ExpanSion of an Existing Business" 0, or Neither 0, V. Last year for which exemption may be applied DATE: SGNED: m==~~~~~ (Property Appraiser) Application to be filed not later than March 1
8 TKM FARMS, NC. - CYPRESS COOLNG, LLC PAYROLL ROSTER AS OF JANUARY 1,2011 HRE EMP DATE # HRE DATE 1 2/25/20112:02 PMC:\Users\rj\Desktop\Economic Dev Board Economic Dev Board
9 TKM FARMS, NC. - CYPRESS COOLNG, LLC PAYROLL ROSTER AS OF JANUARY 1, 2011 HRE EMP HRE EMP H DATE # DATE # DATE
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EXHBT "B" BOARD OF COUNTY COMMSSONERS OF PALM BEACH COUNTY ECONOMC DEVELOPMENT AD VALOREM TAX EXEMPTON PROGRAM ANNUAL REPORT FOR EXEMPTON PEROD: January 1, 2012 to December 31, 2012 As required by Section
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