Clean Technology Exclusion Worksheet - Office Of The Treasurer & Tax Collector printable pdf download

CITY AND COUNTY OF SAN FRANCISCO

Cert #___________

Office of the Treasurer & Tax Collector

Business Tax Section

Clean Technology Exclusion Worksheet

for Payroll Tax Year 20__

Qualifying for the Clean Technology Exclusion

The clean technology exclusion applies to all San Francisco businesses that employ a full-time staff of not more than 100 employees and is engaged in

a clean technology business. If your business qualifies as a clean technology business, then all compensation paid in direct support of the business’

clean technology efforts may be excluded from the payroll expense tax base, subject to the conditions and limitations set forth in the San Francisco

Business and Tax Regulations Code, Section 906.2. (Note: Independent contractors shall not be considered employees of the clean technology

business and do not qualify for this tax exclusion.)

Please print neatly or type using black ink. Form must be signed to be valid.

Section 1: Business Information

Enter Federal Employer Identification number:

Enter Business Tax Certificate number:

Enter name of business:

Enter principal San Francisco business location: (Street address)

Does your company engage in clean technology business in more than one location in San Francisco?

Yes

Check Yes or No. If yes, list each location address below:

(a)

(b)

Section 2: Payroll Tax Exemption Information

Enter total number of employees:

Enter total number of employees working outside of San Francisco:

Enter total Payroll Expense paid to employees in Line 7:

Section 3: Clean Technology Exclusion Exemption Information

Enter total number of San Francisco employees:

10.

Enter total number of San Francisco employees for which the Clean Technology Exclusion is claimed:

11.

Enter total Payroll Expense paid to employees in Line 10:

Section 4: Calculation of Total Exclusion

12.

Enter the sum of Lines 8 and 11 above. Enter this amount also on your Payroll Tax Statement (Long Form), Line

2. Attach this worksheet to your Payroll Expense Tax statement and file both by the Payroll Tax deadline.

I understand that the facts supporting my application for the Clean Technology Exclusion, as set forth on this worksheet, are subject to audit by the San

Francisco Tax Collector. Under the laws of the State of California, I declare under penalty of perjury that I have read the foregoing and that it is true,

correct, and complete to the best of my knowledge and belief.

Sign:

Date: _____/_____/_____

Print Name:

Contact Number: (

)

Title:

Fax Number: (

)

For questions, please contact Taxpayer Assistance at (415) 554-4400.

Clean Technology Exclusion

Rev. 12/09/09