Form M500 - Jobz Tax Benefit Report - 2012
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1
2Form M500, JOBZ Tax Benefit Report 2012
Use this form to report the sales tax incentives the qualified business received for participating in a Job Opportunity Building Zone (JOBZ).
Name of qualified business
Taxpayer name (if different from JOBZ business)
JOBZ ID number
Business address in the zone
FEIN
City
State
Zip code
County
Minnesota tax ID number
MN
Taxpayer:
C-Corporation
S-Corporation
Partnership
Individual
Fiduciary
Other (specify):
Business contact’s name (first, last)
Title
Daytime phone
Email address of qualified business (optional)
Primary parcel ID (if more than one, attach a sheet)
Zone Tax Benefits
1 Did you receive any zone tax benefits in 2012?
Yes. Continue with line 2.
No. Explain your situation below, sign at the bottom and file this form by the due date:
Sales Tax Exemptions
2 Purchases you made in 2012 of tangible personal property (not including capital equipment
or purchases exempt as a part of product production cost) and services primarily used or
consumed in the zone that would otherwise have been taxable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Purchases you and/or your contractor made in 2012 of construction materials and supplies
used to construct or improve real property used by the qualified business in the zone . . . . . . . . . . . . . . . . . . 3
4 Purchases made in 2012 of motor vehicles that are principally garaged
in the zone and primarily used to carry out your zone operations
(enter each vehicle’s VIN number and purchase price; if you have more than 4 vehicles,
complete Form M500A, JOBZ Motor Vehicle Purchase Report - see instructions) . . . . . . . . . . . . . . . . . . . . . . 4
VIN
$
VIN
$
VIN
$
VIN
$
5 Is the qualified business located in an area with
Enter
a local sales and use tax (see instructions)? . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 No
Yes
the area:
I declare that this report is correct and complete to the best of my kno
wledge and belief.
Signature of authorized representative of qualified business
Date
Do not include Form M500 with your tax return.
By October 15, 2013, mail this form and a copy of your Schedule JOBZ, if any, to:
Minnesota Revenue
Mail Station 9901
St. Paul, MN 55146-9901
Phone: 651-556-6836
Fax: 651-556-3102
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