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2. Application for Commercial/Industrial Community Reivestment Area Tax Incentives from the City of North Canton, Stark County, Ohio.
4. 1. a. Applicant / Property Owner Information
6. Company*
7. Contact Person*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Email Address*
18. 1. b. Project Site Information
20. Contact Person (If different from above)
22. Phone Number
23. Email Address
25. Address*
27. City*
28. State*
29. Zip Code*
31. 2. a. Nature of commercial or industrial activity to be performed at site.*
    -- Select One --ManufacturingWarehousingWholesaleRetailMixed UseOther
32. If other please describe:
34. 2. b. NAICS Number*
    Please provide the business entity's primary 6 digit North American Industry Classification System Number.
35. SIC Numbers
    Please list any other relevant SIC numbers.
37. 2. c. If a consolidation, what are the components of the consolidation? (must itemize the location, assets, and employment positions to be transferred) *
39. 2. d. Form of Business Enterprise*
    -- Select One --Individual proprietor or single member LLCC CorporationS CorporationPartnershipTrust/estateLimited Liability CoporationOther
40. 3. Name of pricipal owner(s) or officers of the business.*
42. 4. a. State the enterprise's current employment level at the proposed project site (itemized for full and part-time and permanent and temporary employees).*
44. 4. b. Will the project involve the relocation of employment positions or assets from one Ohio location to another?*

    1. Yes
    2. No
45. 4. c. If yes, state the locations from which employment positions or assets will be relocated and the location to where the employment positions or assets will be located.
47. 4. d. State the enterprise's current employment level in Ohio (itemized for full and part-time and permanent and temporary employees).*
49. 4. e. State the enterprise's current employment level for each facility to be affected by the relocation of employment positions or assets.
51. 4. f. What is the projected impact of the relocation, detailing the number and type of employees and/or assets to be relocated?
53. Current employment level in Ohio*
    Please state the enterprise's current employment levels in Ohio itemized by full and part-time and permanent and temporary employees.
55. 5. Does the property owner owe:
57. Deliquent Taxes to the State of Ohio or any political subdivision thereof?*

    1. Yes
    2. No
58. Any monies to the State or a State agency for the administration or enforcement of an environmental Laws?*

    1. Yes
    2. No
59. Any monies to the State, political subdivision thereof, or a State agency that are past due?*

    1. Yes
    2. No

    Whether such amounts are contested in a court of law or not.
61. If yes to any of the above, please provide details of each instance, including but not limited to, the location, amounts and/or case identification numbers.
    Supporting documents may be attached below.
63. 6. Project Description*
65. Project timeline provided a tax exemption is provided.
67. Project will begin on*
    Project will begin on
68. Project will be completed by*
    Project will be completed by
70. 8. a. Estimate the number of new employees the property owner will cause to be created at the facility that is the project site (job creation projection must be itemized by the name of the employer, full and part-time and permanent and temporary).*
72. 8. b. State the time frame of this projected hiring in years.*
73. 8. c. State proposed schedule for hiring (itemize by full and part-time and permanent and temporary employees).*
75. 9. a. Estimate the amount of annual payroll such new employees will add in USD.
76. Total*
78. Full-time Permanent*
79. Part-time Permanent*
80. Full-time Temporary*
81. Part-time Temporary*
83. 9. b. Indicate separately the amount of existing annual payroll relating to any job retention claim resulting from the project in USD.
84. Total*
86. Full-time Permanent*
87. Part-time Permanent*
88. Full-time Temporary*
89. Part-time Temporary*
91. 10. An estimate of the amount to be invested by the enterprise to establish, expand, renovate or occupy a facility in USD:
92. Total*
94. Acquisition of Buildings*
95. Additions/New Construction*
96. Improvements to Existing Buildings*
98. Machinery & Equipment*
99. Furniture & Fixtures*
100. Inventory*
102. Please attach a current form W-9 for the site owner..*
103. Please attach any other supporting documents you have.
105. 11. a. Applicant requests the following tax exemption incentives covering real property and investments as described above.
     Be specific as to the rate, and term.
106. Rate as a Percentage*
107. Term in Years*
109. 11. b. Applicant's reasons for requesting tax incentives (be quantitatively specific as possible).*
111. Agreements
     Submission of this application expressly authorizes the City of North Canton to contact the Ohio Environmental Protection Agency to confirm statements contained within this application including item # 5 and to review applicable confidential records. As part of this application, the property owner may also be required to directly request from the Ohio Department of Taxation, or complete a waiver form allowing the Department of Taxation to release specific tax records to the local jurisdiction considering the request.
113. The Applicant agrees to supply additional information upon request.
115. The Applicant acknowledges that this application will not be processed by the City of North Canton unless the local application fee of $100.00 has been paid by the Applicant.
117. The Applicant affirmatively covenants that the information contained in and submitted with this application is complete and correct and is aware of the ORC Sections 9.66(C) (1) and 2921.13(D) (1) penalties for falsification which could result in the forfeiture of all current and future economic development assistance benefits as well as a fine of not more than $1,000 and/or a term of imprisonment of not more than six months.
119. Name of Property Owner*
120. Date*
     Date
122. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
124. Electronic Signature
125. Title*
127. Satements of Compliance with Ohio Revised Code
     A copy of this proposal must be forwarded by the City of North Canton to the affected Board of Education along with notice of the meeting date on which the City Council will review the proposal. Notice must be given a minimum of fourteen (14) days prior to the scheduled meeting to permit the Board of Education to appear and/or comment before the legislative authorities considering the request.
129. Please note that copies of this proposal must be included in the finalized Community Reinvestment Area Agreement as "Exhibit A" and be forwarded to the Ohio Department of Taxation and the Ohio Development Services Agency within fifteen (15) days of final approval.
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131. 1. Receive an email copy of this form.
132. Email address

     This field is not part of the form submission.

133. Submit Submit and Print

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