NEW YORK CITY DEPARTMENT OF FINANCE RELOCATION AND EMPLOYMENT ASSISTANCE PROGRAM (REAP-ADD) TM Finance DATE STAMP APPLICATION FOR CERTIFICATE OF ELIGIBILITY OF DESIGNATED ADDITIONAL OR REPLACEMENT PREMISES FOR UNINCORPORATED BUSINESS TAX, GENERAL CORPORATION TAX, BANKING CORPORATION TAX, OR UTILITY TAX SECTION A: APPLICANT INFORMATION APPLICANTʼS COMPANY NAME: SOCIAL SECURITY NUMBER: CONTACT PERSON: OR EMPLOYER IDENTIFICATION NUMBER: ADDRESS: CITY/STATE: ZIP CODE: MAIN BUSINESS ACTIVITY: TELEPHONE NUMBER: SECTION B: CURRENT REAP PREMISES Are you currently receiving REAP benefits at one or more business locations within the eligible REAP area? ........................................................................................................................... K YES If “YES,” complete the following schedule for the location(s), and attach copies of your REAP Certification Form(s). STREET ADDRESS REAP-ADD Rev. 11/23/11 CITY AND STATE NATURE OF ACTIVITIES NUMBER OF EMPLOYEES K NO DATES AT LOCATION Visit Finance at nyc.gov/finance American LegalNet, Inc. www.FormsWorkFlow.com REAP-ADD - Application for Certificate of Eligibility of Designated Additional or Replacement Premises Page 2 SECTION C: INFORMATION ON ADDITIONAL OR REPLACEMENT PREMISES You may complete and submit this application for an anticipated move, even if all the requested information is not yet available. If your current eligible premises are within a revitalization area, your additional or replacement premises must also be in a revitalization area. A revitalization area is defined as any district in the city zoned C4, C5, C6, M1, M2, or M3, except the area that is south of 96th Street in Manhattan. Premises cannot be certified as additional or replacement premises if you maintained employment shares there prior to this application for certification. 1. Do you intend to move to premises within the eligible REAP area? .............................................. K YES K NO K YES K NO K YES K NO (1) Premises are wholly contained in real property that is eligible to receive benefits under the Cityʼs Industrial and Commercial Incentive Program (ICIP)? ............................ K YES K NO (2) Premises are wholly contained or situated on real property that has been leased from the NYC Industrial Development Agency? ................................................................ K YES K NO (3) Premises are wholly contained in or situated on real property that is owned by the City of New York? ................................................................................................... K YES K NO (4) Premises are wholly contained or situated in real property that is owned by the Port Authority or the New York State Urban Development Corporation or a subsidiary thereof? ..................................................................................................... K YES K NO (5) Premises are wholly contained in or situated in real property that would be eligible to receive benefits pursuant to the Cityʼs ICIP Program, except that such property is exempt from real property taxation?.................................................................................. K YES K NO If “YES,” provide (a) the borough, block and lot number, the address of the premises you intend to move to, and submit one of the following: a copy of the lease for the premises, a copy of the contract to purchase the premises, or a copy of the deed if you own the premises; AND (b) a brief description of the business operations that will be moved. a. BOROUGH: b. ADDRESS: BLOCK: LOT: DESCRIPTION OF BUSINESS OPERATIONS THAT WILL BE MOVED: 2. a. Do you own the premises to which you plan to move, or if you will lease the premises, does the term of the lease extend to a date at least three years after the relocation date and the lease commencement date? ....................................................................................... b. Were expenditures in excess of $25 per square foot made for improvements to the premises, on or after July 1, 2003? If not, do you intend that such expenditures will be made? ........................................................................................................................... IF YOU ANSWERED “YES” TO 2a AND 2b, DO NOT COMPLETE QUESTION 3. IF YOU ANSWERED “NO” TO ANY PART OF QUESTION 2, YOU MUST COMPLETE QUESTION 3. 3. a. Do the premises to which you are moving fit any of the following five categories? If YES, submit a copy of the lease and the ICIP Preliminary Certificate of Eligibility. If YES, submit a copy of the lease. If YES, submit a copy of the lease. If YES, submit a copy of the lease. If YES, submit a copy of the lease and the ICIP Preliminary Certificate of Eligibility. American LegalNet, Inc. www.FormsWorkFlow.com REAP-ADD - Application for Certificate of Eligibility of Designated Additional or Replacement Premises Page 3 SECTION C: INFORMATION ON ADDITIONAL OR REPLACEMENT PREMISES - Continued 3. b. (1) Have the premises to which you are moving been improved by construction or renovation? ............................................................................................... (2) Answer only if you answered “YES” to Question 3a: (2) Was such construction or renovation made with the approval of the NYC Industrial Development Agency? ....................................................................................... c. (3) Answer only if you answered “YES” to Question 3a: (3) Was such construction or renovation made with the approval of your lease in accordance with the NYC Charter? ................................................................................... (1) Have there been expenditures for improvements to the real property in which your new premises will be located that were in excess of 50% (or, in the case of industrial property, in excess of 25%) of the propertyʼs assessed value, or the tax year in which the improvements began?........................................................... (2) If you answered “YES” to 3c: (1), were these expenditures made within 36 months of the commencement of the work, or, if the expenditures are in excess of $50 million, were they made within 72 months of the commencement of the work?....... IF YOU ANSWERED “YES” TO QUESTION 3b AND/OR 3c, DESCRIBE AND DOCUMENT THE CONSTRUCTION OR RENOVATION WORK PERFORMED AND IMPROVEMENT MADE TO THE REAL PROPERTY BY ATTACHING A SEPARATE PAGE TO THIS APPLICATION. K YES K NO K YES K NO K YES K NO K YES K NO K YES K NO SECTION D: REAP-ADD CERTIFICATION I hereby certify that the information furnished with or in this application is, to the best of my knowledge and belief, true, correct and complete. __________________________________________________________________________________________________________________________ Print Name and Title of Applicant, Partner or Corporate Officer ________________________________________________________________________ Signature ________________________________________ Date MAIL TO: NYC DEPARTMENT OF FINANCE BUSINESS AND EXCISE TAX REFUND UNIT - REAP GROUP 59 MAIDEN LANE, 20TH FLOOR, NEW YORK, NY 10038 American LegalNet, Inc. www.FormsWorkFlow.com