Business Incentive Grant Application

Town of South Hill
211 S. Mecklenburg Ave
South Hill, VA 23970-2619
Phone: 434-447-3191 Fax: 434-447-5064

Name of Applicant*
Address*
I OWN THE PROPERTY AT THE ADDRESS UNDER APPLICANT INFORMATION*

Property Owner Information (if different than applicant)

(If the answer to the last question was NO, you must complete this section)

Property Owner Name*
Property Owner Address*
IS THE ADDRESS OF THE PROPERTY THAT IS SUBJECT TO THIS GRANT APPLICATION THE SAME AS THE ADDRESS LISTED UNDER APPLICANT INFORMATION? *

ADDRESS OF THE PROPERTY SUBJECT TO THIS GRANT APPLICATION

(If the answer to the last question was NO, you must complete this section)

OTHER INFORMATION

Have you ever obtained a business license in the Town of South Hill, VA?*
Is or will your business be in the defined Downtown Zone? - Copy*
(Please refer to page 19, Downtown Map, in the Business Incentives package to answer this question)
Town Wide Grants
Downtown Zone Grants
$

Supporting files (limit of 25 MB of data per form submission, not per file)

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APPLICANT CHECKLIST:

1. I certify that all taxes and fees owed to the Town of South Hill, VA are current, and I have no outstanding balances: *
2. I have attached all supporting documentation that is required for the grant that I am applying for:*
3. I understand the permits I am required to obtain from the Town of South Hill, VA to proceed with my application: *
4. I understand that all grants/incentives are paid in the form of a stimulus payment upon meeting all qualification requirements:*

Your signature below indicates you have read, understand, and agree to comply with Program Guidelines.

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Date Applied*

INTERNAL USE ONLY

1. Based on the review of this application, the applicant qualifies for the following incentive grants:

Town Wide Grants Qualified
Downtown Zone Grants Qualified
2. Applicant has no outstanding taxes or fees owed to the town:*
3. Applicant has provided all supporting documentation required:*
4. Applicant is aware and has agreed to obtain all appropriate permits: *
Application Status*
Reviewed By:*
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