Form 135-A - New/expanded Business Facility And Enterprise Zone: Application For Subsequently Claiming Tax Benefits
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MoDED-135-A
MISSOURI DEPARTMENT OF ECONOMIC DEVELOPMENT
MISSOURI FORM
NEW/EXPANDED BUSINESS FACILITY AND ENTERPRISE ZONE:
APPLICATION FOR SUBSEQUENTLY CLAIMING TAX BENEFITS
READ PAGES 7-8 OF INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORM
SCHEDULES S AND M MUST ACCOMPANY THIS APPLICATION WHICH
MUST BE FILED EACH YEAR FOLLOWING YEAR ONE
FOR CALENDAR YEAR 19 -OR TAX YEAR BEGINNING
19 -, ENDING
NAME OF FACILITY
FACILITY FEDERAL I.D. NO.
AND
ADDRESS OF FACILITY (WHERE DEVELOPMENT OCCURRED)
STREET
P 0. BOX
TAXPAYER FEDERAL I.D. NO.
PRINT
OR
AND
COUNTY
ZIP CODE
C I T Y
FACILITY MISSOURI TAX I.D. NO.
(MITS)
MISSOURI
1. Is this address within a designated enterprise zone? (See instructions, page 7)
Yes
No
2. Name and mailing address if different than above (See instructions, page 8):
NAME
ADDRESS (STREET, P 0. BOX, CITY, STATE, ZIP CODE)
3. Name, address and telephone of person completing application (See instructions, page 8):
NAME
TELEPHONE NUMBER
ADDRESS (STREET, CITY, STATE, ZIP CODE)
4. Business entity for tax purposes (See instructions, page 8):
q
4a.
Corporation
4b. 0 Fiduciary
4d. 0 Partnership 4e. 0 S-Corp.
NOTE:
IF THE TAXPAYER IS A FIDUCIARY, PARTNERSHIP OR S-CORPORATION, IDENTIFY THE NAMES, SOCIAL SECURITY NUMBERS AND PROPORTIONED
THE LAST DAY OF THE TAX PERIOD.
SHARE OF OWNERSHIP OF EACH BENEFICIARY, PARTNER OR SHAREHOLDER ON
A G G R E G A T E P R O P O R T I O N A T E
SHARES OR PERCENT OF TOTAL OWNERSHIP MAY NOT EXCEED 100%. ATTACH A SEPARATE SHEET IF NECESSARY.
NAME(S)
SOCIAL SECURITY NO.(S)
%
6
%
I
%
Describe the business activity(ies) conducted at this facility. Be specific. (See instructions, page 8)
5.
5a. Enter the facility’ s 4-digit Standard Industrial Classification (SIC) number if known: _
6. Tax years for which this facility’ s tax benefit has been certified if known (See instructions, page 8):
Total Amount of Credits
Certified by State
Claimed on MO Return
6a. 1st year: Beginning
19 _ Ending
6a
6b. 2nd year: Beginning
19 - Ending
6b
1 9 - E n d i n g
6d. 4th year: Beginning
6d
6e. 5th year: Beginning
19 _ Ending
6e
6f. 6th year: Beginning
19 - Ending
6f
a
6g. 7th year: Beginning
1 9 - E n d i n g
W
6h. 8th year: Beginning
19 _ Ending
6h
6i. 9th year: Beginning
19 _ Ending
6i
19 _ Ending
MO 419-1524 (12-95)
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