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    Cf7b Random Name 1

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    Field 2

    Field 3

    Field 4

    Field 20

    Sectioniapplicantinformation

    Applicantname

    Applicantaddress

    Phone

    Fax

    Website

    Federalid

    Naics

    Stateandyearorincorporationorganization

    Listofstockholdersmembersorpartnersofapplicant1

    Listofstockholdersmembersorpartnersofapplicant2

    Willarealestateholdingcompanybeutilizedtoowntheprojectpropertyfacility

    YesNo

    Whatisthenameoftherealestateholdingcompany

    Federalid_2

    Stateandyearorincorporationorganization_2

    Listofstockholdersmembersorpartnersofrealestateholdingcompany1

    Listofstockholdersmembersorpartnersofrealestateholdingcompany2

    Name 0001

    Title

    Address

    Phone_2

    Fax_2

    Name_2

    Title_2

    Address_2

    Phone_3

    Fax_3

    Nameofattorney

    Firmname

    Address_3

    Phone_4

    Fax_4

    Typicallyfornotforprofitssmallqualifiedmanufacturers

    Yes_2Yes_3Yes_4Yes_5

    Undefined

    No_2No_3No_4No_5

    Undefined_2

    Undefined_3

    Publiccorporation

    Undefined_4

    Soleproprietorship

    Limitedliabilitycompany

    Otherpleasespecify

    Yearestablished

    Stateinwhichorganizationisestablished

    Name1

    Name2

    Name3

    Ofownership1

    Ofownership2

    Ofownership3

    Determiningeligibility1

    Determiningeligibility2

    Determiningeligibility3

    Estimatedofsaleswithincountycitytownvillage

    Estimatedofsalesoutsidecountycitytownvillagebutwithinnewyorkstate

    Estimatedofsalesoutsidenewyorkstatebutwithintheus

    Estimatedofsalesoutsidetheus

    Eachprovidesupportingdocumentationincludingestimatedpercentageoflocalpurchases1

    Eachprovidesupportingdocumentationincludingestimatedpercentageoflocalpurchases2

    Sectioniiprojectdescriptiondetails

    Municipalityormunicipalitiesofcurrentoperations

    Willtheproposedprojectbelocatedwithinthemunicipalityorwithinamunicipalityidentifiedabove

    Yes_6No_6

    Ifyesinwhichmunicipalitywilltheproposedprojectbelocated

    Ifnoinwhichmunicipalitywilltheproposedprojectbelocated

    Providethepropertyaddressoftheproposedproject

    Iftheproposedprojectislocatedinadifferentmunicipalitythanthemunicipalityinwhichcurrent

    If the proposed project is located in a different municipality than the municipality in which current

    No_7

    No_7

    Ifyesyouwillneedtocompletesectioniiqandsectionivofthisapplication

    If yes you will need to complete Section II Q and Section IV of this Application

    No_8

    No_8

    Sblnumberforpropertyuponwhichproposedprojectwillbelocated

    Whatarethecurrentrealestatetaxesontheproposedprojectsite

    Land

    Buildingss

    Yes_7

    Yes_7

    Noifnopleaseexplain

    No If no please explain

    Undefined_5

    Arerealpropertytaxescurrent

    Towncityvillage

    Schooldistrict

    Undefined_6

    Yes_8No_9

    Doestheapplicantoranyrelatedentitycurrentlyholdfeetitletotheprojectsite

    Undefined_7

    Yes_9No_10

    Doesapplicantorrelatedentityhaveanoptioncontracttopurchasetheprojectsite

    Describethepresentuseoftheproposedprojectsite1

    Describethepresentuseoftheproposedprojectsite2

    Describeanyandall

    Shortfallsexpansionneedslocationyoureligibilitydeterminationwillbebasedinpartonyour

    Pleaseconfirmbycheckingtheboxbelowifthereislikelihoodthattheprojectwouldnotbe

    Undertakenbutforthefinancialassistanceprovidedbytheagency

    Yes_10No_11

    Provideastatementinthespaceprovidedbelowindicatingwhytheprojectshouldbeundertakenby

    Theagency1

    Theagency2

    Theagency3

    Theagency4

    Iftheapplicantisunabletoobtainfinancialassistancefortheprojectwhatwillbetheimpacton

    Theapplicantandcountycitytownvillage1

    Theapplicantandcountycitytownvillage2

    Cwillprojectincludeleasinganyequipment

    C Will Project include leasing any equipment

    Yes_11

    Yes_11

    Ifyespleasedescribe

    Undefined_8

    undefined_8

    Yes_12

    Yes_12

    Willtheprojectmeetzoninglanduserequirementsattheproposedlocation

    Describerequiredzoninglanduseifdifferent

    Ifachangeinzoninglanduseisrequiredpleaseprovidedetailsstatusofanyrequestforchangeof

    Zoninglanduserequirements

    Istheproposedprojectlocatedonasitewheretheknownorpotentialpresenceofcontaminantsis

    Complicatingthedevelopmentuseofthepropertyifyespleaseexplain1

    Complicatingthedevelopmentuseofthepropertyifyespleaseexplain2

    Proposedprojectsite

    Yes_13

    Yes_13

    Indicatetheknownorsuspectedpresenceofcontaminationthatwouldcomplicatethesitesdevelopment

    indicate the known or suspected presence of contamination that would complicate the sites development

    Yes_14

    Yes_14

    Noifyespleaseprovidecopiesofthestudy

    Gprovideanyadditionalinformationordetails1

    Gprovideanyadditionalinformationordetails2

    Retailsales

    Retail Sales

    Yesor

    Yes or

    Services

    Services

    Yesor_2

    Yes or_2

    Tocustomerswhopersonallyvisittheproject

    Undefined_9

    Acquisitionofexistingfacility

    Acquisition of Existing Facility

    Undefined_10

    Undefined_11

    Undefined_12

    Undefined_13

    Undefined_14

    Undefined_15

    Undefined_16

    Undefined_17

    Civicfacilitynotforprofit

    Undefined_18

    Landandorbuildingacquisition

    Acres

    Newbuildingconstruction

    Newbuildingadditions

    Reconstructionrenovation

    Otherspecify

    Undefined_19

    Undefined_20

    Undefined_21

    Undefined_22

    Undefined_23

    Undefined_24

    Undefined_25

    Undefined_26

    Undefined_27

    Totalcapitalcosts

    Identifyeachstateandfederalgrantcredit1

    Identifyeachstateandfederalgrantcredit2

    Identifyeachstateandfederalgrantcredit3

    Identifyeachstateandfederalgrantcredit4

    Undefined_28

    Undefined_29

    Undefined_30

    Undefined_31

    Undefined_32

    Undefined_33

    Undefined_34

    Undefined_35

    Undefined_36

    Undefined_37

    Undefined_38

    Haveanyoftheabovecostsbeenpaidorincurredasofthedateofthisapplication

    Yes_15No_12

    Ifyesdescribeparticulars1

    Ifyesdescribeparticulars2

    Mortgageamountincludesumtotalofconstructionpermanentbridgefinancing

    Undefined_39

    Totalcostofconstruction

    Undefined_40

    Sourcedincountycitytownvillage

    Includingcountycitytownvillage

    Undefined_41

    Undefined_42

    Undefined_43

    Theagencyspilotbenefit

    Squarefootagemanufacturingprocessing

    Costmanufacturingprocessing

    Oftotalcostofprojectmanufacturingprocessing

    Squarefootagewarehouse

    Costwarehouse

    Oftotalcostofprojectwarehouse

    Squarefootageresearchdevelopment

    Costresearchdevelopment

    Oftotalcostofprojectresearchdevelopment

    Squarefootagecommercial

    Costcommercial

    Oftotalcostofprojectcommercial

    Squarefootageretailseesectionk

    Costretailseesectionk

    Oftotalcostofprojectretailseesectionk

    Squarefootageoffice

    Costoffice

    Oftotalcostofprojectoffice

    Squarefootagespecifyother

    Costspecifyother

    Oftotalcostofprojectspecifyother

    Field 1startdateacquisitionofequipmentorconstructionoffacilities

    Field 3projectoccupancyestimatedstartingdateofoperations

    Undefined_44

    Field 4haveconstructioncontractsbeensigned

    Yes_16No_13

    Field 5hasfinancingbeenfinalized

    Yes_17No_14

    Listcontractorsfortheproject1

    Listcontractorsfortheproject2

    Listcontractorsfortheproject3

    Lhavesiteplansbeensubmittedtotheplanningdepartment

    Yes_18No_15

    Hastheprojectreceivedsiteplanapprovalfromtheplanningdepartment

    Ifyespleaseprovidetheagencywithacopyoftheplanningdepartmentapprovalalongwiththerelated

    Yes_19No_16

    Mistheprojectnecessarytoexpandprojectemployment

    Yes_20Yes_21

    Undefined_45

    No_17No_18

    Currentofjobsatproposedprojectlocationortoberelocatedtoprojectlocationfulltimefte

    Iffinancialassistanceisgrantedprojectthenumberoffteandptejobstoberetainedfulltimefte

    Iffinancialassistanceisgrantedprojectthenumberoffteandptejobstobecreatedupontwoyearsafterprojectcompletionfulltimefte

    Estimatenumberofresidentsofthelabormarketareainwhichtheprojectislocatedthatwillfillthefteandptejobstobecreatedupontwoyearsafterprojectcompletionfulltimefte

    Currentofjobsatproposedprojectlocationortoberelocatedtoprojectlocationparttimepte

    Iffinancialassistanceisgrantedprojectthenumberoffteandptejobstoberetainedparttimepte

    Iffinancialassistanceisgrantedprojectthenumberoffteandptejobstobecreatedupontwoyearsafterprojectcompletionparttimepte

    Estimatenumberofresidentsofthelabormarketareainwhichtheprojectislocatedthatwillfillthefteandptejobstobecreatedupontwoyearsafterprojectcompletionparttimepte

    Currentofjobsatproposedprojectlocationortoberelocatedtoprojectlocationtotal

    Iffinancialassistanceisgrantedprojectthenumberoffteandptejobstoberetainedtotal

    Iffinancialassistanceisgrantedprojectthenumberoffteandptejobstobecreatedupontwoyearsafterprojectcompletiontotal

    Estimatenumberofresidentsofthelabormarketareainwhichtheprojectislocatedthatwillfillthefteandptejobstobecreatedupontwoyearsafterprojectcompletiontotal

    Averagesalaryorrangeofsalarymanagement

    Averagefringebenefitsorrangeoffringebenefitsmanagement

    Averagesalaryorrangeofsalaryprofessional

    Averagefringebenefitsorrangeoffringebenefitsprofessional

    Averagesalaryorrangeofsalaryadministrative

    Averagefringebenefitsorrangeoffringebenefitsadministrative

    Averagesalaryorrangeofsalaryproduction

    Averagefringebenefitsorrangeoffringebenefitsproduction

    Averagesalaryorrangeofsalaryindependentcontractor

    Averagefringebenefitsorrangeoffringebenefitsindependentcontractor

    Averagesalaryorrangeofsalaryother

    Averagefringebenefitsorrangeoffringebenefitsother

    Addressfulltime

    Addressfulltime_2

    Addressfulltime_3

    Addressparttime

    Addressparttime_2

    Addressparttime_3

    Addresstotal

    Addresstotal_2

    Addresstotal_3

    Pwillanyofthefacilitiesdescribedabovebeclosedorsubjecttoreducedactivity

    Yes_22No_19

    Qistheprojectreasonablynecessarytopreventtheprojectoccupantfrommovingoutofnewyorkstate

    Yes_23No_20

    Ifyespleaseexplainandidentifyoutofstatelocationsinvestigatedtypeofassistanceofferedandprovide

    Supportingdocumentationifavailable1

    Supportingdocumentationifavailable2

    Undefined_46

    Rwhatcompetitivefactorsledyoutoinquireaboutsitesoutsideofnewyorkstate1

    Rwhatcompetitivefactorsledyoutoinquireaboutsitesoutsideofnewyorkstate2

    Shaveyoucontactedorbeencontactedbyotherlocalstateandorfederaleconomicdevelopment

    Yes_24No_21

    Dollaramountthatisanticipatedtobereceived

    Sectioniiiretailquestionnaire

    Yes_25

    Yes_25

    Noiftheanswerisyespleasecontinueifnoproceedtosectionv

    No If the answer is yes please continue If no proceed to section V

    Bwhatpercentageofthecostoftheprojectwillbeexpendedonsuchfacilitiesorpropertyprimarily

    Usedinmakingsalesofgoodsorservicestocustomerswhopersonallyvisittheproject

    Willtheprojectbeoperatedbyanotforprofitcorporation

    Yes_26No_22

    Undefined_47

    Yes_27No_23

    Offeringsuchgoodsorservices

    Yes_28No_24

    Permanentprivatesectorjobsinthestateofnewyork

    permanent private sector jobs in the State of New York

    No_25

    No_25

    Yes_29

    Ifyespleaseexplain

    Istheprojectlocatedinahighlydistressedarea

    Yes_30No_26

    Sectionivintermunicipalmovedetermination

    Fromoneareaofthestatetoanotherareaofthestate

    Yes_31No_27

    Undefined_48

    Yes_32No_28

    Reasonablynecessarytopreservetheprojectoccupantscompetitivepositioninitsrespectiveindustry1

    Reasonablynecessarytopreservetheprojectoccupantscompetitivepositioninitsrespectiveindustry2

    Reasonablynecessarytopreservetheprojectoccupantscompetitivepositioninitsrespectiveindustry3

    Doestheprojectinvolverelocationorconsolidationofaprojectoccupantfromanothermunicipality

    Yes_33Yes_34

    Undefined_49

    No_29No_30

    Ifyestoeitherquestionpleaseexplain1

    Ifyestoeitherquestionpleaseexplain2

    Schooltax

    Yearrow1

    Countytaxrow1

    Citytaxrow1

    Schooltaxrow1

    Dollarvalueofnewconstructionandrenovationcostsrow1

    Estimatednewassessedvalueofpropertysubjecttoidarow1

    Countytaxrate1000row1

    Localtaxratetowncityvillage1000row1

    Schooltaxrate1000row1

    Pilotyear

    Payment1

    Countypilotamount1

    Localpilotamount1

    Schoolpilotamount1

    Totalpilot1

    Fulltaxpaymentwopilot1

    Netexemption1

    Payment2

    Countypilotamount2

    Localpilotamount2

    Schoolpilotamount2

    Totalpilot2

    Fulltaxpaymentwopilot2

    Netexemption2

    Payment3

    Countypilotamount3

    Localpilotamount3

    Schoolpilotamount3

    Totalpilot3

    Fulltaxpaymentwopilot3

    Netexemption3

    Payment4

    Countypilotamount4

    Localpilotamount4

    Schoolpilotamount4

    Totalpilot4

    Fulltaxpaymentwopilot4

    Netexemption4

    Payment5

    Countypilotamount5

    Localpilotamount5

    Schoolpilotamount5

    Totalpilot5

    Fulltaxpaymentwopilot5

    Netexemption5

    Payment6

    Countypilotamount6

    Localpilotamount6

    Schoolpilotamount6

    Totalpilot6

    Fulltaxpaymentwopilot6

    Netexemption6

    Payment7

    Countypilotamount7

    Localpilotamount7

    Schoolpilotamount7

    Totalpilot7

    Fulltaxpaymentwopilot7

    Netexemption7

    Payment8

    Countypilotamount8

    Localpilotamount8

    Schoolpilotamount8

    Totalpilot8

    Fulltaxpaymentwopilot8

    Netexemption8

    Payment9

    Countypilotamount9

    Localpilotamount9

    Schoolpilotamount9

    Totalpilot9

    Fulltaxpaymentwopilot9

    Netexemption9

    Payment10

    Countypilotamount10

    Localpilotamount10

    Schoolpilotamount10

    Totalpilot10

    Fulltaxpaymentwopilot10

    Netexemption10

    Paymenttotal

    Countypilotamounttotal

    Localpilotamounttotal

    Schoolpilotamounttotal

    Totalpilottotal

    Fulltaxpaymentwopilottotal

    Netexemptiontotal

    Totalprojectcostrow1

    Estimatedvalueofpilotrow1

    Estimatedvalueofsalestaxincentiverow1

    Estimatedvalueofmortgagetaxincentiverow1

    Totalofotherpublicincentivestaxcreditsgrantsesdincentivesetcrow1

    Undefined_50

    Undefined_51

    Undefined_52

    Undefined_53

    Undefined_54

    Undefined_55

    Undefined_56

    Sectionvirepresentationscertificationsandindemnification

    Nameofceoorotherauthorizedrepresentativeofapplicant

    Confirmsandsaysthathesheisthe

    Titleof

    Beingfirstdulysworndeposesandsays

    Applicantandthatiamdulyauthorizedonbehalfoftheapplicanttobindtheapplicant

    Corporateofficeof

    Notarypublic

    Areyouapplyingforataxincentiveundertheadaptivereuseprogram

    Yes_35No_31

    Whatistheageofthestructureinyears

    Isdefinedasaminimumof50oftherentablesquarefootageofthestructurebeingutilizedforausefor

    Whichthestructurewasnotdesignedorintended

    Yes_36No_32

    Definedasincomethatis50orlessthanthemarketrateincomeaverageforthatpropertyclass

    Yes_37No_33

    Ifyespleaseprovidedollaramountofincomebeinggeneratedifany

    Doesthesitehavehistoricalsignificance

    Yes_38No_34

    Areyouapplyingforeitherstateandorfederalhistoricaltaxcreditprograms

    Summarizethefinancialobstaclestodevelopmentthatthisprojectfaceswithoutagency

    Yes_39No_35

    Averagereturnoninvestmentratescomparedtoregionalindustryaverages1

    Averagereturnoninvestmentratescomparedtoregionalindustryaverages2

    Field 1_2

    Field 2_2

    Fromtheseentities1

    Fromtheseentities2

    Field 1_3

    Field 2_3

    Payments

    Field 1_4

    Field 2_4

    Field 3_2

    Signature1_es_signersignature

    cf7b-random-name-1