Form K-34 - Business And Job Development Credit Page 3

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Name ___________________________
EIN _______________
Location _________________________________
P
ART C – (continued)
(G)
(H)
( I )
(J)
(K)
(L)
Year End Date: __ __ __ __
Year End Date: __ __ __ __
Year End Date: __ __ __ __
Year End Date: __ __ __ __
Year End Date: __ __ __ __
Year End Date: __ __ __ __
Number of Employees
Number of Employees
Number of Employees
Number of Employees
Number of Employees
Number of Employees
25.
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P
ART D – (continued)
(G)
(H)
( I )
(J)
(K)
(L)
Year End Date: __ __ __ __
Year End Date: __ __ __ __
Year End Date: __ __ __ __
Year End Date: __ __ __ __
Year End Date: __ __ __ __
Year End Date: __ __ __ __
Monthly Investment
Monthly Investment
Monthly Investment
Monthly Investment
Monthly Investment
Monthly Investment
44.
45.
46.
47.
48.
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50.
51.
52.
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55.
56.
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