Form Nc-478d - 1999 Tax Credit Worker Training 10-99 - North Carolina Department Of Revenue Page 2
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1
2NC-478D Reverse
Part 3.
Information on Employees Trained
(Attach additional pages if needed.)
Wages Paid
Tier of
Residence in
Employee’s Name
SSN
Location of Job
Period of Training
During Training
Residence
Dev. Zone?
Part 4.
Certifications
I certify that the taxpayer filing this form meets the requirements for claiming this tax credit and that the information
given on this form is, to the best of my knowledge, accurate and complete.
Signature of Taxpayer
or Authorized Agent:
Date:
NC
478D
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