Form Rev 81 1026 - High Unemployment County Application For Sales And Use Tax Deferral - Washington Department Of Revenue Page 3
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1
2
3Employment Information
Audit Records Location
17. Lessee’s average number of Full Time Equivalents (FTEs)
If your application is approved, a deferral certificate will be
for previous calendar year.
issued using the estimates from your application. Upon
(1820 annualized hours worked = 1 FTE):
completion of the project, an auditor will verify that you are
performing qualified activities at this facility. They will also
Lessee’s entire business:
verify that the approved percentage of your structure and
At this facility:
100% of the machinery and equipment are eligible for the
deferral. The auditor may adjust the allowable deferral
18. Estimated number of new FTEs as a
based on his or her findings and you will be billed for all
result of this project:
non-qualifying purchases.
If your investment project is located in a qualifying county,
To minimize inconvenience and the time it takes to complete an
please skip question 19.
audit, please have the following records for the audit period
19. If your investment project is located in a community
available for your meeting with the auditor:
empowerment zone (CEZ), you must hire at least one
Purchase invoices (i.e., accounts payable, receipts)
qualified employment position for each $750,000 of
investment on which a deferral is approved. The persons
Supporting documentation for the construction, such as
must be hired after the date the application is filed with the
construction contracts
department. Each qualified employment position must be
Original Sales and Use Tax Deferral Certificate
filled by persons who at the time of hire are residents of the
CEZ, or the county that contains the CEZ. If, by the end of
Although most audits can be completed with the above records,
the second calendar year following the year in which the
additional documents may be required during the audit.
project is certified as operationally complete, you have not
Please complete the following information about the contact
hired and retained for twelve calendar months the required
person and audit records location if this information is currently
number of qualified employment positions, all deferred
available:
taxes are immediately due.
22. Contact person:
Estimated number of qualified fulltime positions that will
be filled by residents of the CEZ or the county that contains
the CEZ:
23. Phone number of contact person:
Name of CEZ:
24. Location of Audit records:
Use of Facility
All businesses must maintain a qualified activity at the site of
the investment project for the year in which the investment
project is certified as operationally complete by Revenue, plus
seven additional years.
Print Name
Yes
No
20. Does the lessee plan to operate this
Title
Date
investment project in a qualified
manner for 8 years from the time
Applicant’s Signature
the project is complete?
21. If the answer to question 20 is “No”,
Questions: Call
(360) 570 3265 option 6
how long does the lessee plan to
Mail or Fax To:
Department of Revenue
operate this investment project
Special Programs Division
in a qualified manner?
______________
PO Box 47477
Olympia, WA 98504-7477
FAX: (360) 586 2163
If the manufacturing or research and development activity is not
maintained, all or a portion of the deferred taxes outstanding for
this investment will be immediately due. The department will
assess interest at the rate provided for delinquent excise taxes,
but not penalties, retroactively to the date of the deferral.
For tax assistance or to inquire about the availability of this document in an alternate format, please call 1-800-647-7706. Teletype (TTY) users
may use the Washington State Relay Service by calling 711.
REV 81 1026 (5/16/13)
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