*140078==19999*
DR 0078 (07/25/14)
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0005
Application for Extended Enterprise Zone Tax Credits
in Terminated Enterprise Zone Area
Joint Certification by Taxpayer and Enterprise Zone Administrator
Date termination of this area officially announced:
Effective date of termination of this zone area:
I. Enterprise Zone
(MM/DD/YY)
(MM/DD/YY)
Middle Initial
II. Corporation or Last Name
First Name
Colorado Account Number
SSN or FEIN
Mailing Address
City
State
Zip
Contact Person's Last Name
Middle Initial
First Name
Location of Enterprise Zone Facility
City
State
Zip
Date Established/Acquired/Planned to be Established by Taxpayer
Phone Number
(MM/DD/YY)
(
)
III. Describe business planning documentation in place prior to the announcement of the zone termination
(do not attach; retain with your tax records and send only if specifically requested by the Department):
Real estate
Plant or equipment
Permit applications (zoning, building,
acquisition plans
purchasing specifications
environmental, etc.)
Utility service applications
Financing plans
Other
If other, please describe
IV. Planned Activity Eligible for Enterprise Zone Tax Credits
through ten years following termination of zone.
Amount of
Tax Credit
Cumulative
Planned
For each applicable credit, first list only the planned and cumulative total amounts
Total Anticipated
when requesting the certification.
Then, complete the areas to designate the year and
Investment,
amount of each credit claimed.
Tax Credits
Jobs, etc.
Contribution to enterprise zone administrator credit
$
$
Year
(YYYY)
Credit
Claimed
Investment tax credit
$
$
Year
(YYYY)
Credit
Claimed
Job training tax credit
$
$
Year
(YYYY)
Credit
Claimed