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2022
VIRGINIA ENTERPRISE ZONE PROGRAM
Real Property Investment Grant Qualification Form
Print on 8 1/2" x 11" paper for your own records.
Please read the 2022 Real Property Investment Grant Instruction Manual before completing this form.
Form EZ-RPIG
PART I: BACKGROUND INFORMATION
1. Qualified Zone Investor's Legal Name
 2. Type of Zone Investor (check one)
3. Federal Employment ID# (FEIN)
4. Physical Address of Zone Establishment
City/County/Town
   Zipcode
5. Real Property Use Classification (check one)

6. Type of Real Property (check one)

7. Type of real property investment that was made




8. Property Identification Number(s)
9. Zone Name
   10. Zone #
   11. Zone Designation Date
   12. Name of Local Zone Administrator
13. Must upload Local Zone Administrator Review in Part IX. Check to confirm the LZA Review document is signed and uploaded.
14. Narrative Summary: See RPIG Manual for Instructions (*maximum characters allowed: 1500)
 
PART II: PLACED-IN-SERVICE DOCUMENTATION
A.
B. Please explain any differences in the name and address listed on the final Placed-in-Service documentation from the name and address listed in Part I, Boxes 1 and 4. Please contact us at ezone@dhcd.virginia.gov if additional space is required to explain discrepancies. A letter from the locality may not be provided in lieu of placed-in-service documentation if a Certificate of Occupancy or Final Building Inspection was required by the locality. Documentation should be dated within the current application Grant Year. (*maximum characters allowed: 1500)
 
PART III: ITEMIZED LIST OF QUALIFIED REAL PROPERTY INVESTMENTS
Total Qualified Real Property Investment:  $ (amount to enter in line 3A)
Must upload Itemized List of QRPI in Part IX. Check to confirm the List is uploaded.
 
PART IV: QUALIFICATION INFORMATION
1.  Date Real Property placed in service (MM/DD/YYYY)
*  To verify this date upload (in Part IX below) a copy of the final Certificate of Occupancy, Final Building Inspection (approved by local jurisdiction), or a licensed third party inspector's report in cases where project did not require a permit. When submitting a licensed third party inspector's report, upload (in Part IX below) a letter from the locality verifying that project did not require any permits.
 1 
2.  Qualification is requested for calendar year (YYYY)  2 
3.  Grant Calculation
  A. Actual dollar amount of qualified real property investments made by applicant.  3A $
  B. Applicable investment threshold based on the type of real property investment.  3B $
  C. Amount of public grant funds received and used to fund qualified real property investments.  3C $
  D. Grant eligible dollar amount. (Line 3A minus Line 3B and Line 3C)  3D $
  E. Multiply line (D) by 20%. This is the amount of grant the zone investor is requesting.
*  For investments (line A) less than $5 million, this amount cannot exceed $100,000.
*  For investments (line A) of $5 million or more, this amount cannot exceed $200,000.
 3E $
4. Real Property Investment Grants previously issued to building or facility.
see RPIG Award Schedule to complete this section.
  A. Have real property investment grants been awarded to the building or facility in the last four years?
If yes, complete section B.		  4A 
  B. If yes, indicating the total amount received in previous years.
The sum of Line 3E and Line 4B shall not exceed the applicable $100,000 or $200,000 investment, per the regulations in Line 3D.		  4B $
 
PART V: CONTACT INFORMATION
1. Name of Grant Applicant Representative
First: Last:		 Title
 Daytime Phone #
 E-mail Address
2. Principal Mailing Address(the grant award is mailed to)
 City
 State
 Zip Code
3. Certified Public Accountant (preparer of required Attestation Report)
Name of Certified Public Accountant
 VA License #
 Daytime Phone #
 E-mail Address
4. Accounting Firm
 Address
City
State
    Zip Code
 
PART VI: APPLICATION INFORMATION
Check the boxes below that apply to your application submission.
1. Application includes Supplemental EZ-RPIG Mixed-Use Form
2. Application includes Supplemental EZ-RPIG Multiple-Owner Form
3. Application includes Supplemental EZ-RPIG Tenant Coordination Form
4. Application includes Supplemental EZ-RPIG Tenant Owner Consent Form
5. Submission includes CPA Attestation Report Form
6. Submission includes Final Placed-in-Service documentation
7. Submission includes Form W-9
 
PART VII: DECLARATION
 
KEEP A COPY OF THIS FORM FOR YOUR RECORDS. The Department may at any time review qualified zone investors records related to qualification to assure that information provided in the application process is accurate. Qualified zone investors shall maintain all documentation regarding qualification for Enterprise Zone incentive grants for a minimum of three years following the receipt of any grant. Real Property Investment Grants that do not have adequate documentation regarding qualified real property investments may be subject to repayment by the qualified zone investor.
The application form(s), final CPA attestation report, and all required documentation are due by April 1st of the calendar year subsequent to the grant year (Part IV, Item 2). Applications submitted by April 1st without the required attestation report shall be considered late applications. If the April 1 deadline falls on a weekend or holiday, applications are due the next business day.
All documents MUST be submitted electronically through the EZ Submission System/Portal. Hard copies are NOT accepted.
Any applications submitted without the required CPA attestation report or submitted after the due date but before May 15th of the calendar year subsequent to the qualification year will be held until the Department determines that funds remain without the need to prorate on-time grant awards. At such time, the Department will review and process such applications on a first-come, first served basis.
 
PART VIII: COMMENTS
Please enter your notes here:
 
PART IX: UPLOAD DOCUMENTS
* Password protected documents will NOT be accepted. All documents must be uploaded separately (one PDF with all of the documents will NOT be accepted).
Placed in Service Documentation*  
CPA Attestation Report Form*  
Itemized List of Qualified Real Property Investments*  
COV Form W-9*  
LZA Review*  
Form EZ-RPIG*  
Form EZ-RPIG Multiple Owner  (If Applicable)
Form EZ-RPIG Tenant-Owner Consent  (If Applicable)
FORM EZ-RPIG - Tenant Coordination  (If Applicable)
FOR EZ-Mixed-Use  (If Applicable)
Additional Information  
Additional Information  
Additional Information  
Additional Information  
Additional Information  
Check COV W-9 Remittance Address to be sure that this is the correct address to which the Department will send the company's grant check.  
 
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