Form 402ap 9901 - Application For New Business Facility Tax Credits

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STATE OF DELAWARE

Department of Finance

APPLICATION FOR NEW BUSINESS FACILITY

Division of Revenue

TAX CREDITS

Reset

820 N. French Street

P.O. Box 8911

Print Form

Wilmington Delaware 19899-8911

FORM 402AP 9901

THIS APPLICATION MUST BE COMPLETED AND FILED WITH THE DIVISION OF REVENUE PRIOR TO CLAIMING ANY

CORPORATE INCOME TAX CREDITS OR REDUCTIONS IN LICENSE TAXES PURSUANT TO CHAPTER 20, TITLE 30, DELAWARE CODE.

PART A -- NAME AND ADDRESS

Federal Employer Identification Number

1 ---

2. Name of Taxpayer

3. Address

4. Location of qualifying business facility (if different from above).

5. Contact Person

Telephone Number

(

)

PART B -- BUSINESS ACTIVITIES

Check the appropriate qualifying activity(s)

Wholesaling

Aviation Maintenance & Repair Services

Management & Support Services for Activities listed

Computer Software Sales (Wholesale Only)

Combination of Activities listed

Consumer Credit Reporting/Collection Services

Occupational Licenses -- Targeted Areas Only

Data Processing or Data Preparation

Retailing -- Targeted Areas Only

Engineering

Other

________________ --

Brownfield Areas Only

Manufacturing

Other

________________ -- Green Industries Only

Scientific, Agricultural or Industrial Research

Telecommunications

Check the appropriate type of facility

New facility

Expansion with new employees

Replacement facility

Expansion without new employees

Located on a Brownfield (Verification required from DNREC)

PART C -- QUALIFYING FACILITY INFORMATION

1. Enter the date the facility was placed in service.

2. Enter the value (at original cost if owned by the taxpayer, or eight times the annual rent paid less any amounts received as subrentals if leased) of

the real and tangible personal property, except inventory or property held for sale to customers, which constitutes the new business facility or

which is used by the taxpayer in the operation of the business facility. Include in this investment amount all costs expended by the taxpayer for

environmental investigation and remediation if such facility is located on a brownfield.

3. If the qualifying facility is leased, provide the name, address and federal employer identification number of the lessor.

F.E.I.N

4. Enter the number of new business facility employees employed by the taxpayer on a regular and full-time basis in the operation of the new,

replaced or expanded facility.

5. If the qualifying facility has been acquired from another, provide the name, address and federal employer identification number of the previous

owner.

F.E.I.N

6. Is the taxpayer or firm related to the individual or firm listed above? [ ] YES

[ ] NO