Form W-1 Kjda - Employers Quarterly Return Of Occupational License Fees Withheld Claiming The Kentucky Jobs Development Authority Credit Page 4

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A licensee claiming a KJDA employer withholding occupational tax credit based upon an economic development inducement
arising from an approved project, pursuant to KRS 154.24 shall file quarterly with the Louisville/Jefferson County Metro
Revenue Commission the following information:
·
The total amount of the licensee’s approved tax credit inducement (one fifth of the total state and local
inducement) was $_________________and the date upon which the project was approved was
__________________.
·
The date when the licensee made the first tax credit claim upon the inducement was ___________________
·
The tax credits claimed arising from the inducement for all quarters prior to the quarter indicated on the first page
of this form was $____________________ .
·
The amount, if any, by which the loca1 inducement has been reduced because the licensee has taken part of its
state inducement as a credit on its corporate income tax is $______________________.
·
The KJDA tax credit claimed on Form W1-KJDA arising from the inducement for the quarter indicated on the
first page of this form is $_____________________.
·
The total remaining occupational tax credits arising from the inducement which the licensee claims is available to
it after recognition of the tax credit claimed for the quarter indicated on the first page of this form is
$______________________.
·
The base number of employees in Jefferson County, Kentucky prior to the approved project and of the number of new
Jefferson County jobs upon which the inducement was calculated was __________and of the licensee’s current
number of employees at the end of the quarter indicated on the first page of this form is ____________.
I have attached the name, Kentucky residential address and social security number of each employee who during the quarter
indicated on the first page of this form was employed by the licensee primarily to work on the approved project and who was
subject to Louisville/Jefferson County withholding tax and upon whose employer tax withholding the KJDA tax credit is
claimed.
I hereby certify, under penalty of perjury, that the activity engaged in by the licensee with respect to which a KJDA tax credit is
claimed was, during the quarter indicated on the first page of this form a “service or technology" activity within the meaning
of KRS 154.24-010 (16) and was the activity as described at the time the KJDA project was approved.
I hereby certify, under penalty of perjury, that the licensee either (i) engages in no business in Kentucky other than that of the
approved KJDA project, or (ii) keeps an account of receipts of the licensee arising from its approved KJDA project as distinct
from all other receipts of the licensee.
I hereby certify, under penalty of perjury, that I have examined the above information and that it is true, correct and complete to
the best of my knowledge and that this company has met the requirements of the KJDA project.
_______________________________________
Signature of Chief Financial Officer
__________________
___________________
Title
Date

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