American Bottoms Enterprise Zone #57 
For Zone Certified Areas in Cahokia, Dupo, Sauget, and the unincorporated area of St. Clair County 
 
PROJECT APPLICATION 
 
Project # (assigned by enterprise zone office):               
 
Please Print:  
Name of Business   applying for Enterprise Zone designation:   
 
                                        
 
Enterprise Zone project  address:                           
     
City, State, Zip:                                     
 
Owner or Contact Person:                   Phone:               
 
Email address:                           Fax:                
 
Tax mailing address:                                   
    
Business Owner   (if different than contact) 
Name of Individual or Company:                               
 
Address:                           Phone:             
 
City, State, Zip:                                     
 
Type of Business:          Commercial             Industrial  
 
Product(s) or Service(s):                                  
 
Building Permit:  
Grantor:                Number                 Date             
 
Estimated Date of Project Start  :                   Estimated Completion Date:                          
                      Date must not be earlier than certificate date         
    
Estimated Cost of Project  :  (A copy of the approved Building Permit must accompany this Application before the 
Certification will be issued.  Amounts for 3 and/or 6 must coincide with building permit)   
 
1) Building Materials Cost for Remodeling:       $                
 
2) Est. Cost of Labor for Remodeling project:       $                
 
3) Total cost of Remodeling (1 & 2)          $                
 
4) Building Materials Cost for New Construction:     $                   
 
5) Est. Cost of Labor  for New Construction:      $                
 

 = Page 1 =
6) Total Cost of New Construction (4 & 5)        $                
 
7) Cost of Capital Equipment:              $                
 
8) Cost of Site (purchase & preparation):         $                
 
9) Total Cost of Building Materials (1 &4)         $                  
 
10)  Total Cost of Labor (2 & 5)             $                
 
11) TOTAL PROJECT COST (7 & 8 & 9 & 10)        $                
 
Enterprise Zone Fee due with application:   
Cost of building materials  (#9)  x  .005 =                          (EZ Fee per 20 ILCS 655/8.2/c.$50,000cap) 
 
Job Creation:   
   Employees Retained due to this project (means the number of documented jobs that will remain in the 
zone when it can be publicly documented the business would close operations, without enterprise zone 
benefits - attach documentation):          
 
   Estimated Number of Full Time Equivalent Jobs created at business site (means the number of jobs for 
which persons are hired or are expected to be hired within one year as a result of the new investment, 
not including construction jobs or spinoff jobs that may be created):          
 
   Estimated Number of Full-time Equivalent Construction Jobs working at project site:              
  
General Description of Proposed Project:    (Include any rehabilitation/remodeling of existing structures, new 
construction, major paving or new equipment.  Use an additional sheet if necessary) 
    
                                        
    
                                        
 
Permanent Parcel Number(s) of project location  :                          
 
                                        
 
Does project involve a move from another location?          Yes         No 
 
If yes, indicated city and state:                             
 
NAICS Code:    (6 digit industry code)                             
Link to the NAICS codes:    http://www.census.gov/cgi-bin/sssd/naics/naicsrch?chart=2007   
 
Federal Employment Identification Number (FEIN)      (nine digits)                    
 
IL Unemployment Insurance Number  :                             
 
Project Representative:                      
 
 
                                                         
Signature of Project Representative                Title                    Date 

 = Page 2 =
NOTE:    A COPY OF THE APPROVED BUILDING PERMIT, PARCEL NUMBER(S), CONTRACTOR 
INFORMATION  AND  THE  ENTERPRISE  ZONE  APPLICATION  FEE  MUST  ACCOMPANY 
APPLICATION  BEFORE  PROJECT  WILL  BE  APPROVED  TO  GO  FORWARD  WITH  SALES  TAX 
EXEMPTION APPLICATION TO THE ILLINOIS DEPARTMENT OF REVENUE.   
 
DO NOT ORDER OR PURCHASE BUILDING MATERIALS BEFORE YOUR SALES TAX CERTIFICATE IS 
ISSUED. ALL INFORMATION REQUESTED ON THE SALES TAX EXEMPTION APPLICATION FORM 
MUST BE COMPLETED.  THIS IS REQUIRED BY STATE LAW.  
 
 
******************************************************************************************* 
(To Be filled in by Enterprise Zone Administrator)  
 
 
 
Application:   Received                  
 
Certification:  Requested through IDOR           
 
 
                               Date Fee Paid        
Signature of Enterprise Zone Administrator  
 
 
Please submit project application to:  
Ms. Chris Anderson   
St. Clair County   IGD   
1  9 Public Square, Suite 200   
Belleville, IL 62220  
618.825.  3218   
E-Mail:    canderson@co.st-clair.il.us
 
 
******************************************************************************    
 
 
INFORMATION  ON  EACH  CONTRACTOR  OR  OTHER  ENTITY  THAT  PURCHASES  BUILDING 
MATERIALS  TO  BE  INCORPORATED  INTO  REAL  ESTATE  WITHIN  THIS  STATE  CERTIFIED  
ENTERPRISE  ZONE  BY  REHABILITATION,  REMODELING  OR  NEW  CONSTRUCTION,  MUST 
COMPLETE  THE  REQUIRED  FORM  PROVIDED  TO  RECEIVE  THE  SALES  TAX  EMEMPTION 
CERTIFICATE FROM THE ILLINOIS DEPARTMENT OF REVENUE. (Please make as many copies of 
the contractor form as needed)  
 
 
 
 

 = Page 3 =
PROJECT NAME:                                     
 
CONTRACTOR INFORMATION     
 
Contractor                                      
 
Trade                                        
 
Owner                                        
 
Mailing Address                               
 
City:                State                Zip           
 
Country               
 
Phone Number                      or   Cell Phone                 
 
E-Mail Address                                     
 
Tax Mailing Address                                    
 
Federal Employer Identification Number (FEIN)                    
 
Illinois Unemployment Insurance Number (UIN)                    
 
Illinois Department of Revenue Applicant ID #:                    
 
Number of workers projected  at project site:                    
 
Estimated Project Start Date:                      
 
Estimated Project Completion Date:                    
 
 
Building Materials Exemption  
 
Contract Amount                   
 
Estimated average tax rate          
 
Percentage of contract that consists of building materials qualifying for exemption        
 
Estimated dollar amount of exemption for purchase materials                
 
 
 
                                     
Contractor Signature                 Date 

 = Page 4 =