I ~I~~E~~NB~~~~~ ~~~3404

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1 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 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. 11. BUSNESS NAME and mailing address: SOUTH FLORDA JANTORAL & POOL SUPPLY ~~~E~~NB~~~~~ ~~~3404 i2.- Name and telephone number of business owner or person in charge of this business:1 Angie Blash (561) Exact location (street address) of property for which this report is filed: Congress Park Lt 9; 2119 congress Ave Riviera Beach, FL j 4. Date you began business activities at this facility: Dec REAL PROPERTY. a) Description of the improvements to real property for which this exemption is requested: ' Development of freestanding office and distribution facility b) Date of commencement of construction of improvements: Feb ]. 6. TANGBLE PERSONAL PROPERTY a) Description of the tangible personal property for which this exemption is requested and date when property was purchased: 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: [$ 115,000 ] ~ ~ 7. Have you maintained the definition of a 0 "New Business" or as an 0 "Expansion of an Existing Business"? 1 g) Yes 0 No 8. Describe the type or nature of your business: Wholesale distributor of janitorial supplies 9. Trade level (check as many as apply): L g) Wholesale 0 Manufacturing 0 Professional OService 0 Office 0 Other 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: [ (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 [ NfA ] and percentage increase since exemption was granted [ % J d) Average annual salary of employees as of January 1 S1 payroll roster with executive positions. $58, e) Average annual salary of employees as of January 1 s1 payroll roster without executive positions. $42, 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 [ $ N A Divided by total sales everywhere from this facility... [ $ ] equals ( % J Percentage increase in productive output resulting from this expansion since year exemption wa~, granted [ %]

2 r J 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: [$ mprovements to real property: [$ Personal Property:..[ $... ] DATE SGNATURE (Property Appraiser) i ~ J

3 12. For office or facility space ownec..cased and used by a corporation newly domiciled i. Jrida: a) Date of incorporation in Florida: N/A b) Number of full time employees at the time of application: [ 1 and currently at this location: [ ~ 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 knowledge and belief. (f prepared by someone other than the taxpayer, his/her declaration is based on all information of which he has any knowledge.) i Taxpayer Name & Title: Preparer Name, Address & Telephone Number: Robert Slate 9310 Old Kings Rd. #1602 fsgnature;~~~~c~~. -J i DATE DATE ~ EXHBT "B". ANNUAL REPORT (cont inued) NOTARZATON OF ANNUAL REPORT. The information provided in the Annual Report is accurate and complete for the business facility identified hereinabove. ~ ;. NOTARY STATE OF FLORDA COUNTY OF Qum T he foregoing instrument was acknowl me this a-day of ~20~ by "'o~ L:e'~ J ifo'"tary Public's Signat Personally Known OR Type ofldentification Produced -==-=.,.J. /" ". ~~'r~,- SAULS. CRAFTON ~ : ~;.&"\~ MY COMMSSON DO ~.~:~l EXPRES: July "'t.p. ;';...~. Bonded Thru Notary Puhlic UrnlerwJiters '11\\ \> L

4 PB 418 (6.a.) AR EXHBT "B" ANNUAL REPORT (continued) ANG.BLE PERSONAL PROPERTY Economic Development Ad Valorem Tax Exemption 6.a. Description of the tangible personal property for which this exemption is requested and date when property was purchased, CLASS OR TEM AGE DATE OF PURCHASE ORGNAL COST GOO AVG D P 0 a R TAXPAYER'S ESTMATE OF FAR MARKET VALUE Desks 2002 X 5,250 File Cabinets 2002 X 1,125 Chairs 2001 X 300 Copier 2002 X 750 Calculators 2001 X 75 Computers 2002 X 1,500 Computers 1999 X 1,500 Fork lift 2003 X Fork lift 2002 X Fork lift ,000 2,500 X _.._- -

5 PB 418 (6.b.) AR EXHBT "B" ANNUAL REPORT (continued) JOBS AND AVERAGE ANNUAL SALAR Economic Development Ad Valorem Tax Exemption -, _ f... _...-._- _, ---- _ _ -'-\:J-' _._. -_ _..1. Exemp tion Period Year Existing Jobs: Applic. New Jobs Obligation 1 FULL-TME JOBS EQUVALENT JOBS SEASONAL JOBS TOTAL JOBS (2,080 Hours) Total Avg. Annual Salary Total Avg. Annual Salary Total Avg. Annual Salary Total Avg. Annual Salary... J?. $58, t-ja...._.. _N~.... J.~. $58, ~ _... _- --_.. _... _ NSTRUCTONS: dentify the Full-Time Jobs above. f there are no Equivalent Jobs or no Seasonal Jobs enter non-applicable (NfA). 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 sd<:~~rf FLORDA JANTORAL PAYROLL'~..lSTER DOH Address City St Zip 1 1/1/ Cypress sland Palm Beach Gardens FL /1/ Cypress sland Palm Beach Gardens FL /27/ N Wallen Dr. Palm Beach FL /21/ SE Woodcrest PL Hobe Sound FL /29f Wedgewood Plaza Dr Riviera Beach FL /11/ th Ct W.Palm Beach FL / N 76 Trail Palm Beach Gardens FL / San Mateo Dr Palm Springs FL /2/ Willows Springs Boynton Beach FL f8/ St W. Palm Beach FL /3/ Marshwood Lane Lake Worth FL /14/ NE 64th St. Ft. Lauderdale FL /1/ NW 89 Way Coral Springs FL / NE 7th St Pompano FL /21/ Palm Beach Lakes West Palm Beach FL /16/ MerryPlace West Palm Beach FL /1/ Via Raphael Delray Beach FL /26/ Dale Rd Palm Springs FL