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Form 135 - New/expanded Business Facility And Enterprise Zone: Application For Initially Claiming Tax Benefits - State Of Missouri

-1 ENDING

-, 19-

1 TAXPAYER FEDERAL I.D. NO.

(MITS)

) If yes, attach Schedule A

4c. 0 Individual Proprietorship

6c. A new facility that replaces an “ old” facility closed by the CURRENT TAXPAYER

0 6a

0 6b

0 6c

0 6d

0 6e

0 6f

MoDED-

MISSOURI FORM

MISSOURI DEPARTMENT OF ECONOMIC DEVELOPMENT

NEW/EXPANDED BUSINESS FACILITY AND ENTERPRISE ZONE:

APPLICATION FOR INITIALLY CLAIMING TAX BENEFITS

READ PAGES 6-7 OF INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORM

SCHEDULES S AND M MUST ACCOMPANY THIS APPLICATION WHICH

MUST BE FILED IN TAX PERIOD AFTER DEVELOPMENT OCCURRED

FOR CALENDAR YEAR 19 _OR TAX YEAR BEGINNING

NAME OF FAClLlTY

FACILITY FEDERAL I.D. NO.

AND

PLEASE

ADDRESS OF FACILITY (WHERE DEVELOPMENT OCCURRED)

STREET

P.O. BOX

TYPE

AND

CITY

COUNTY

ZIP CODE

FACILITY MISSOURI TAX I.D. NO.

MISSOURI

1. Is this address within a designated enterprise zone? (See instructions, page 6)

Yes

2. Name and mailing address if different than above (See instructions, page 6):

NAME

ADDRESS (STREET, P.O. BOX, CITY, STATE, ZIP CODE)

3. Name, address and telephone of person completing application (See instructions, page 6):

NAME

TELEPHONE

NUMBER

4. Business entity for tax purposes (See instructions, page 6):

4a. Cl 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

SHARE OF OWNERSHIP OF EACH BENEFICIARY, PARTNER OR SHAREHOLDER ON

TAX PERIOD. AGGREGATE PROPORTIONATE

SHARES OR PERCENT OF TOTAL OWNERSHIP MAY NOT EXCEED 100%. ATTACH A SEPARATE SHEET IF NECESSARY.

NAME(S)

SOCIAL SECURITY NO.(S)

% OWNERSHIP YEAR END

5. Describe the business activitiy(ies) conducted at this facility. Be specific. (See instructions, page 6)

5a. Enter the facility’ s 4-digit Standard Industrial Classification (SIC) number if known: ~

Which of the following BEST describes the facility where the development occurred? (See instructions, page 6)

(CHECK ONLY ONE):

6a. A new facility (recently organized & formed)

6b. A new facility to Missouri (relocation or expansion from another state)

6d. A new facility in addition to another or other OPEN AND OPERATING Missouri facilities

6e. An expansion of an existing facility (attached to an existing structure)

6f. An expansion of an existing facility (separated from existing structure(s) but on same site)

SHORT DESCRIPTION OF DEVELOPMENT (See instructions, page 6). (Attach separate sheet(s) if necessary):

MO 4191524 (12-95)

Form 135 - New/expanded Business Facility And Enterprise Zone: Application For Initially Claiming Tax Benefits - State Of Missouri

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