Form 28276 - Qualifi Ed Seed Capital Business Investment Reporting - North Dakota Office Of State Tax Commissioner

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North Dakota Offi ce of State Tax Commissioner
Qualifi ed seed capital business investment reporting form
► This form is for reporting investments made in tax years beginning on or after January 1, 2007—see instructions.
► This form must be completed by the qualifi ed business.
Investment information
Date of investment ►
Amount of investment ►
Type of investor:
 Individual
 Partnership
 “C” Corporation
 “S” corporation
 Estate or trust
Social security
Name of investor ______________________________________
number or FEIN _______________________
Spouse’s name,
Spouse’s social
if joint investment _____________________________________
security number _______________________
Address __________________________________ City __________________ State _______ ZIP _____________
Qualifi ed business
Name of qualifi ed business _________________________________________
FEIN ______________________
Signature of authorized representative ________________________________
Date ______________________
Printed name of authorized representative ____________________________
General instructions
The investment must remain at risk
Note: Any person may invest in the
for at least three years from the date
qualifi ed business, but only eligible
This form must be used by a qualifi ed
of investment to maintain its qualifi ed
taxpayers are allowed the tax credit.
business to report the receipt of a
status.
qualifi ed investment from an eligible
If an eligible taxpayer is a passthrough
taxpayer for purposes of the seed capital
An individual who is a participant in a
entity—partnership, S corporation, or
investment tax credit under N.D.C.C. ch.
retirement plan is deemed to have made
limited liability company treated like a
57-38.5.
a qualifi ed investment in the case of a
partnership or “S” corporation—the tax
direct transfer (by the trustee) of monies
credit is calculated at the passthrough
Important: Unless otherwise provided
from the retirement plan to a qualifi ed
entity level and passed through to its
by a change in law, these instructions
business if (1) a separate retirement
owners.
only apply to investments made by
plan account is maintained for the
eligible taxpayers in tax years beginning
Date of investment—The “date of
individual, (2) the monies come out of
on or after January 1, 2007. For this
investment” means the date on which
the individual’s account, and (3) the
purpose, the tax year of the eligible
a qualifi ed investment is received and
individual controls where the account’s
taxpayer (investor) is used, not that of the
is available for use by the qualifi ed
assets are invested.
qualifi ed business.
business. The taxpayer’s tax year in
Eligible taxpayer— An “eligible
which the date of investment falls is the
For purposes of investments reported on
taxpayer” means an individual, estate,
fi rst tax year in which the tax credit is to
this form, the following defi nitions apply:
trust, partnership, corporation (“C” or
be used.
Qualifi ed investment—A “qualifi ed
“S”), or limited liability company. An
Qualifi ed business investment limit—
investment” means one that meets all of
eligible taxpayer does not include any of
Only the fi rst $500,000 of qualifi ed
the following conditions:
the following:
investments received by a qualifi ed
•
•
It is made by an eligible taxpayer—see
Government entity.
business over its lifetime are eligible
“Eligible taxpayer” below.
for the tax credit. This limitation does
•
Tax-exempt organization.
not preclude additional investment in
•
It is in the form of a cash payment.
•
Real estate investment trust.
the qualifi ed business for which no tax
•
It is made within the certifi cation
credits are allowed. For purposes of this
•
Taxpayer owning more than 50 percent
period specifi ed in the certifi cation
limit, tax credits are allowed to eligible
of the qualifi ed business.
confi rmation letter issued to the
taxpayers in the chronological order of
•
qualifi ed business by the North Dakota
Taxpayer receiving more than 50
their investments, based on the date of
Commerce Department.
percent of annual gross income from
investment reported on this investment
the qualifi ed business.
reporting form.
•
It is at risk in the qualifi ed business. An
•
investment is at risk when it is available
Spouse, parent, sibling, or child (or
to the qualifi ed business for its use.
a spouse of a sibling or child) of an
Monies placed in escrow are not at risk.
ineligible taxpayer.
28276
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