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I 12
MISSOURI DEPARTMENT OF ECONOMIC DEVELOPMENT
MISSOURI SCHEDULE
NEW/EXPANDED BUSINESS FACILITY AND ENTERPRISE ZONE:
EMPLOYEES AND INVESTMENT CREDITS
READ PAGES 9-11 OF INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORM
FOR CALENDAR YEAR 19 -OR TAX YEAR BEGINNING
19
NAME OF FACILITY
FACILITY FEDERAL I.D. NO.
AND
TAXPAYER FEDERAL I.D. NO.
THIS SCHEDULE MUST BE FILED EACH YEAR TAX BENEFITS ARE CLAIMED.
ATTACH THIS SCHEDULE TO FORM 135 OR 135-A, WHICHEVER IS APPLICABLE.
AND
FACILITY MISSOURI TAX I.D. NO.
COMPUTING “ NEW BUSINESS FACILITY EMPLOYEES” AND “ NEW BUSINESS FACILITY
(MITS)
INVESTMENT”
NEW BUSINESS FACILITY EMPLOYEES (FULL-TIME OR
NEW BUSINESS FACILITY INVESTRhENT (ORIGINAL COST/
MONTHS
20 HRS. OR 80% SEASON, LAST WORK DAY EACH MONTH)
8 TIMES ANNUAL RENT, LAST WORK DAY EACH MONTH)
(A) CURRENT YEAR
(B) BASE YEAR
(C) CURRENT YEAR
(D) BASE YEAR
TAX YEAR ENDING
TAX YEAR ENDING
TAX YEAR ENDING
TAX YEAR ENDING
COLUMN
LINE
1
2
3
4
5
6
6
7
9
10
10
11
11
12
13
T O T A L 1
I
I
14
AVERAGE
14
ADD AND DIVIDE BY NUMBER OF FULL
15
MONTHS IN OPERATION
16
17
18
19
20
INVESTMENT
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS SCHEDULE, AND TO THE BEST OF MY
KNOWLEDGE AND BELIEF, IT IS TRUE, CORRECT AND COMPLETE.
TAXPAYER’ S OR DESIGNEE’ S SIGNATURE
DATE
PREPARER’ S SIGNATURE
DATE
ACCOMPANY FORM 135 OR 135-A WHICHEVER IS APPLICABLE.
MUST
CLAIMS FOR TAX BENEFITS AND
MAIL ALL
ALL RELATED INQUIRIES TO:
TAX BENEFIT PROGRAMS
MISSOURI DEPARTMENT OF ECONOMIC DEVELOPMENT
P.O. BOX 118
JEFFERSON CITY, MISSOURI 65102
MO 4191524 (12-95)