Qualified Investor Certification Application Individual
Download a blank fillable Qualified Investor Certification Application Individual in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Qualified Investor Certification Application Individual with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4Form NDEDQI-I
Nebraska Department of Economic Development
Angel Investment Tax Credit
Qualified Investor Certification Application - Individual
NOTE: TAX CREDITS MAY ONLY BE UTILIZED BY RESIDENTS OF THE STATE OF NEBRASKA. ONLY
NEBRASKA RESIDENTS WHO ARE OTHERWISE ELIGIBLE TO UTILIZE AN ALLOCATION OF TAX CREDITS
WILL BE ALLOCATED ANY ANGEL INVESTMENT TAX CREDITS.
Section I. Name and identifying information
Legal Name (“Investor”):
Street Address:
City:
State:
Zip:
Phone: __
SSN: _________________________
E-mail: _________________________________
Section II. Qualified Investment
A.
Does the Investor intend to make a “Qualified Investment” in a Qualified Small Business
pursuant to the Nebraska Angel Investment Tax Credit Program (“Program”) totaling at least
$25,000.00? Note: Qualified Investors who invest in Qualified Funds are not required to make a
$25,000 minimum Qualified Investment in a Qualified Small Business.
No
Yes
B.
Has the Investor already made the Qualified Investment for which it seeks allocation of
Nebraska Angel Investment Tax Credits (“Tax Credits”) prior to submitting this application for
certification?
No
Yes (indicate date of investment _____________________________)
Section III. Investor
A.
Is the Investor an “accredited investor” under Rule 501 of Regulation D under the Security Act of
1933, as in effect on January 1, 2011?
Not an accredited investor
Investor qualifies as an accredited investor for the following reason(s) (check below
all that apply)
4836-2671-9498.3
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial