Ag Commodity Processing Facility Investment Reporting Form - North Dakota Office Of State Tax Commissioner
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1North Dakota Offi ce of State Tax Commissioner
Ag commodity processing facility investment reporting form
► Applies to investments made on or after January 1, 2007.
Instructions for
○ An eligible taxpayer does not include
statement of full consideration. See
a government entity or a tax-exempt
N.D.C.C. § 57-38.6-03(8) for complete
qualifi ed business
organization.
details.
Use this form only if you have been
•
The investment is at risk. An investment
certifi ed by the North Dakota Commerce
Instructions for investor
is at risk when it is available to the
Department’s Division of Economic
This form is evidence of your investment
business for its use. Monies placed in
Development and Finance as a qualifi ed
in a qualifi ed agricultural commodity
escrow are not at risk.
business for purposes of the agricultural
processing facility. Keep it for your
commodity processing facility
A taxpayer who is a participant in a
records.
investment tax credit program under
retirement plan with a separate account
N.D.C.C. ch. 57-38.6.
Amount of tax credit. To determine
maintained for the participant and who
the amount of the tax credit allowed for
controls where the account’s assets
The information on this form applies
your investment, see the instructions to
are invested is deemed to have made a
to investments made on or after
your North Dakota income tax return
qualifi ed investment in the case of a direct
January 1, 2007.
fi led for the tax year in which the date of
transfer of monies from the account to
You must complete and fi le this form for
investment (as shown on this form) falls.
a qualifi ed business. When completing
each qualifi ed investment received. Do
this form, enter the name, address, and
Passthrough entity. If you are a
not complete or fi le this form for an
social security number of the individual
partnership, S corporation, or a limited
investment that does not qualify for the
(participant), not the retirement plan.
liability company treated like passthrough
tax credit. A qualifi ed investment is one
entity, the tax credit must be calculated at
Filing instructions. Give a copy of the
that meets all of the following conditions:
the passthrough entity level and passed
completed form to the investor. Keep a
•
The investment is made in cash or a
through to the owners or benefi ciaries
copy for your fi les. File a copy of this
fee simple interest in real property
based on their respective interests in the
form with each of the following agencies:
located in North Dakota. See
•
entity. See the instructions to Form 58
Offi ce of State Tax Commissioner
N.D.C.C. §§ 57-38.6-01(4) and
(partnership), Form 60 (S corporation), or
600 E. Boulevard Ave. Dept. 127
57-38.6-03(8) for complete details.
Form 38 (trust) for more information.
Bismarck, ND 58505-0599
•
The investment is made on or after the
•
Economic Development & Finance
Contact Information
date the qualifi ed business was certifi ed.
PO Box 2057
•
The investment is made by an eligible
If you have questions, contact us at:
Bismarck, ND 58502-2057
taxpayer.
•
(701) 328-1247
For an investment of a fee simple
○ An eligible taxpayer means an
(TDD/TTY call 1-800-366-6888 - ask
interest in real property, the copy of this
individual, estate, trust, partnership,
for 701-328-1247)
form fi led with the Offi ce of State Tax
regular (“C”) corporation, S
•
individualtax@nd.gov
Commissioner must be accompanied by:
corporation, or limited liability
•
(1) a copy of the required appraisal, (2) a
Offi ce of State Tax Commissioner
company that is required to fi le a
copy of the qualifi ed business’s governing
600 E. Boulevard Ave. Dept. 127
North Dakota income tax return.
body’s resolution approving the value
Bismarck, ND 58505-0599
of the investment, and (3) a copy of the
Investment information
▼
Date of investment ►
Amount of investment ►
Investor’s tax type:
Individual
Partnership
Corporation
S corporation
Estate/trust
Limited liability company
Social security
Name of investor ______________________________________
number or FEIN _______________________
Spouse’s name,
Spouse’s social
if joint investment _____________________________________
security number _______________________
Address __________________________________ City __________________ State _______ ZIP _____________
Business certifi cation
▼
Name of qualifi ed business _________________________________________
FEIN ______________________
Signature of authorized representative ________________________________
Date ______________________
Printed name of authorized representative _____________________________
28214
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