EXHIBIT "B" BOARD OF COUNTY COMMISSIONERS OF PALM BEACH COUNTY ECONOMIC DEVELOPMENT AD VALOREM TAX EXEMPTION PROGRAM ANNUAL REPORT FOR EXEMPTION PERIOD: January 1, 2011 to December 31, 2011 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. BUSINESS NAME and mailing address: SOUTH FLORIDA JANITORIAL & POOL SUPPLY 2119 CONGRESS AVE. RIVIERA FL 2. Name and telephone number of business owner or person in charge of this business: Slash 848-7002 3. 4. Date business activities at this 5. 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. TANGIBLE 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: [$ 256,310.00 ] 7. Have you maintained the definition of a 0 "New Business" or as an 0 "Expansion of an Existing Business"? IE Yes 0 No 8. Describe the type or nature of your business: 9. Trade level (check as many as apply): Wholesale distributor of IE Wholesale 0 Manufacturing 0 Professional 0 Service 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: [ 18 ]. (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 [N/A ] and percentage increase since exemption was granted [ %] d) Average annual salary of employees as of January 1 st payroll roster with executive positions. $44,124.34 e) Average annual salary of employees as of January 1 st payroll roster without executive positions. $25,262.54 11. TOTAL SALES Sales factor for the facility requesting exemption: Total sales in Palm Beach County ending December 31 st of prior year from this facility [ $ NI A Divided by total sales everywhere from this facility + [ $ ] equals [ %] Percentage increase in productive output resulting from this expansion since year exemption was granted [ %]
12. For office or facility space owned or leased and used by a corporation newly domiciled in Florida: a) Date of incorporation in Florida: N/A b) Number of full-time employees at the time of application: [ I 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. I 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/her declaration is based on all information of which he has any knowledge.) '-T-axpayer Name-&Titie :- ------------ ------ ----r ~~~:~ ~~~:,- AddreSS-&- TeiePhoneNumber :--- ---- ---------.. -- I i i 9310 Old Kings Rd. #1602 I I SI:NATU~ =_====j~~~:~~~~~-~ 5 ~~_,.~~==j U?!-l~. LQA~.._..._......_......_..._... -..1 EXHIBIT "B". ANNUAL REPORT (continued) NOTARIZATION OF ANNUAL REPORT I. The information provided in the Annual Report is accurate and complete for the business facility identified hereinabove. II. NOTARY 5..frtf-t9 of f.: 1or-Ic\(\ CD,,) (\ t-y Or OU V(l ( S~UL B. CRAFTON _ MY COMMISSION # 00 906968 i*1 EXPIRES: July 26. 2013. ~ Bonded Thill Nolart Public Un<!eIWl1 lels Rf" " #tz;6 SO\.l.Ll (~ ND~ r, fjvb \le ~y CO' "\ <9<P J ~ \y ~ (p \ '20 ls
PROPERTY APPRAISER'S USE ONLY I. 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: II. Estimate of the taxable value lost to the County: [ Personall-'rt'lnArl'''' SIGNATURE (Property Appraiser)
PB-418 (6.a.) I AR EXHIBIT "B". ANNUAL REPORT (continued) TANGIBLE PERSONAL PROPERTY Economic Development Ad Valorem Tax Exemption 6.a. 0 escnp. f Ion 0 f th e t an91 'bl e persona prope rt y f or W h' IC h tho IS exemp f Ion IS reques td e an ddt a e W h en prope rt tv was purc h ase d. CLASS OR ITEM Desks File Cabinets Chairs Copier Calculators Computers Computers Fork lift Fork lift Fork lift AGE DATE OF PURCHASE ORIGINAL COST 2001 2001 1999 2003 1997 G A p TAXPAYER'S ESTIMATE OF 0 v 0 0 G 0 FAIR MARKET VALUE 0 R X 5,250 X 1,125 X 300 X 750 X 75 X 1,500 X 1,500 X 3,000 X 2,500 X 500
EXHIBIT "B". ANNUAL REPORT (continued) II JOBS AND AVERAGE ANNUAL SALARY II Economic Development Ad Valorem Tax Exemption ification of the annual status of Total Jobs and Average Annual Salary as of January 1 st Year FULL-TIME JOBS EQUIVALENT JOBS SEASONAL JOBS (2,080 Hours) TOTAL JOBS Total Avg. Annual Salary Total Avg. Annual Salary Total Avg. Annual Salary Total Avg. Annual Salary bs: Applic. 18 ------------ $44,124.34 N/A ------------- N/A ------------- )bligation ------------ -------------- ------------- I 18 $44,124.34 -------------- -------------- JCTIONS: Identify the Full-Time Jobs above. If there are no Equivalent Jobs or no Seasonal Jobs enter non-applicable (N/A). These job figures are restricted to the facility or facilities that are located in Palm Beach County. Refer to Item # 10 on the Annual Report concerning additional job and salary data requirements.
SOUTH FLORIDA JANITORIAL PAYROLL ROSTER
2011 of Exemption - - Return to : PBC Property Appraisf Econt.".c Oevelopment Ad Valorem Propen., Chapter 196.1995, Florida Statutes ')1/2011 :I ax Exemption To be filed with the Board of County Commissioners, the governing boards of the municipality, or both, no later than March 1 of the year the exemption is desired to take effect. 1. Business Name and Mailing Address: SOUTH FLORIDA JANITORIAL & POOL SUPPLY 2119 CONGRESS AVE. RIVIERA BEACH, FL 33404 2. Please give name and telephone number of Owner or Person in charge of this Business. Name Angie Blash 2011 RENEWAL DR-418 R. 12/99 Telephone Number--,(c,.5.,...6...,.1.!...)8_4-",8_-7_0_0...,.2--,.,...,-.."..-,-,:--, Congress Park Lt 9', 2119 Congress Ave Riviera Beach FL33404 3. Exact Location (Legal Description and Streel Address) of Property for which this relum is filed '--'-_-""-_---' --'-'- -"' 4. Date you began, or will begin, business al this facility: 1!.!2"'1"'2::.0=0"'2=- 5. a. Description of the improvements to real property for which this exemption is requestecld '-- N/A b. Date of commencernenl of construction of improvernents:-!2=/2=0,,0"'2=--------------------------------- 6 a. D escnp. r Ion 0 fth e t angl 'bl e persona prope rtyf orw h' 10 h thl s exemp Ion I reques t e d an dd aew t en props rty was, oris t a be pure asb TAXPAYER'S ESTIMATE OF TAXPAYER'S " 0 DATE APPRAISER'S Condition ESTIMATE OF ~ OF ORIGINAL Il D FAIR MARKET USE ONLY l " 0 CLASS OR ITEM AGE PURCHASED COST S '< VALUE 0 *see attached* b. Average Value of inventory on hand:_.!!:$:!"2:!5~6~,"'3:!..1.!..0=.0~0':!... c. Any additional personal property nollisted above for which an exemption Is claimed must be returned on form DR 405 (Tangible Personal Property Tax Return) and a copy attached to Ihis form. 7. Do you desire exemption as a "New Business" 0 or as an "Expansion of an Existing Business" 0 8. Describe Type or Nature of Your Business: Wholesale Distribution of Janitorial Supplies 9. Trade Level (Check as many as apply) RelaliD Wholesalel.l Manufaclurlng :::J Professional 0 Service 0 OfficeD Olher:::J 18 10. a. Number of full-time employees 10 be employed In Florida b. If an expansion of an existing business: (1) Net increase in employmenl-.-jn'-'!li"'al.----------------------------------- or % (2) Increase in productive output resulting from this expansion 11. Sales faclor for Ihe facility requesting exemption: Tolal sales in Florida from this facllity one (1) localion only divided by Tolal sales everywhere from Ihis facility one (1) localion only 12. For office space owned and used by a corporation newly domiciled in Florida: ---------------_% a. Date of incorporation in Florida:_-'-N"ILA..L.. b. Number of full'lime employees allhis location: I 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. I 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. I hereby certify that the information and valuation slaled above by me is Irue, correct, and complele 10 Ihe best of my knowledge and belief. (If prepared by someone olher Ihan the laxpaye, 7- "7,-it DATE: ~ SIGNED: ~~------~~~~~~---- Robert Slate (Preparer) SIGNED:-------------------------r("T-a=xp=a~ye~r')------------------------------ TITLE: Property Appraiser's Use Only 9310 Old Kings Rd. #1602 Jacksonville, FL 32257 (Preparer's Address) (904)636-0466 (Pre parer's Telephone Number) Total revenue available to the county or municipality for the current fiscal year from ad valorem tax sources: % II. Revenue lost to the county or municipality for the current fiscal year by virtue of exemptions previously granted under this section: IIi. Estimale of Ihe revenue Which would be lost 10 Ihe county or municipality during the currenl fiscal year if Ihe exemplion applied for were granled and Ihe property for which Ihe exemption Is requesled would otherwise have been subject to taxation: IV. Estimale of Ihe laxable value losllo Ihe county or municipality if Ihe exemption applied for was granted: Improvemenls 10 real property Personal Property V. I have delermined Ihallhe property lisled above meets Ihe definition, as defined by Section 196.012(15) or (16), Florida Stalules, as a New Business D, an "Expansion of an Existing Business" D, or Neither:::J, Vi. Laslyear for which exemption may be applied DATE: SIGNED:----------------~(~pr-o-pe-rty~A-pp~ra~iS~e~r)-------------------- Application to be filed not later than March 1
PB 418 (6.a. ) I AR EXHIBIT "B" ANNUAL REPORT (con'tinued) ERSONAL PROP 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 ITEM AGE DATE OF PURCHASE ORIGINAL COST, Desks File Cabinets Chairs 2001 Copier Calculators 2001 Computers Computers 1999 Fork lift 2003 Fork lift j Fork lift 1997 G A p TAXPAYER'S ESTIMATE OF 0 v 0 FAIR MARKET VALUE 0 G 0 D R X 5,250 X 1,125 X 300 X 750 X 75 X 1,500 X 1,500 X 3,000 X 2,500 X 500
f I'ltf FLORIDA JANITORIAL PAYROl :uster DOH Address City St Zip 1 1/1/95 14522 Cypress Island Palm Beach Gardens FL 33410 2 1/1/98 14522 Cypress Island Palm Beach Gardens FL 33410 3 2/27/98 12431 N Wallen Dr. Palm Beach FL I 33410 I----+--~~~~~~--~~~~~---+~~~----:-~~~--+=----~---- 11_--=---c~:-+-~::-c-~~-:--~-c~~_~-----iI-:-~4--,--8~_~_~-c-E:-ed---,~,,---~ ~_~c_~d_es_~_i:_;a~d_r --+i:--:-~-:-~b=-i:'-cr;_~--=~:-~_~--:h.~~h%:g~ 61 5/11/00 i 928 30th Ct. iw.palm Beach FL i 33407 7 r - 12/29/00 _~11 N'-:--76=-=T=-r----:ai-:---1 -- I'palm Beach GEirCleils ifl t -33410 8 1/30106 ~~?7: San Mateo Dr Palm Springs FL 33461 1----9_~-1-1-~-IO-1 ii-73-0-7-w~iii-ow-s-s~p~r-in~g-s~~-~bo~y~n_to_n_b_e_a_ch~ ~_F_L _~~ 10 1 11/8/01 '163744St W.PalmBeach FL 33407 11 12/3/01 8095 Marshwood Lane Lake Worth FL 33467 12 10/14/02 2117 NE 64th St. Ft. Lauderdale FL 33308 13 1/1/04 5515 NW 89 Way Coral Springs FL 33067 14 7/30104 900 NE 7th St Pompano FL 33060 15 2/21/05 1329 Palm Beach Lakes West Palm Beach FL 33401 16 7/16/07 1931 Merry Place West Palm Beach FL 33407 17 6/1110 13931 Via Raphael Delray Beach FL 33446 18 7/26/10 3946 Dale Rd Palm Springs FL 33406