Form 135 - A - Application For Subsequently Claiming Tax Benefits Page 2
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36.
Tax years for which this facility’s tax benefit has been certified if known.
Total Amount of Credits
Certified by
Claimed on
State
MO Return
st
6a. 1
year:
Beginning:
____________________
Ending:
____________________
$ _________
$ _________
nd
6b. 2
year:
Beginning:
____________________
Ending:
____________________
$ _________
$ _________
rd
6c. 3
year:
Beginning:
____________________
Ending:
____________________
$ _________
$ _________
th
6d. 4
year:
Beginning:
____________________
Ending:
____________________
$ _________
$ _________
th
6e. 5
year:
Beginning:
____________________
Ending:
____________________
$ _________
$ _________
th
6f.
6
year:
Beginning:
____________________
Ending:
____________________
$ _________
$ _________
th
6g. 7
year:
Beginning:
____________________
Ending:
____________________
$ _________
$ _________
th
6h. 8
year:
Beginning:
____________________
Ending:
____________________
$ _________
$ _________
th
6i.
9
year:
Beginning:
____________________
Ending:
____________________
$ _________
$ _________
th
6j.
10
year:
Beginning:
____________________
Ending:
____________________
$ _________
$ _________
7.
If this new or expanded facility was leased from another person(s), enter the net MONTHLY rental/lease cost. INCLUDE ANY
LEASED LAND, BUILDING(S), MACHINERY, EQUIPMENT, FURNITURE, FIXTURES AND ANY OTHER TANGIBLE PERSONAL
DEPRECIABLE PROPERTY IN USE EXCEPT INVENTORIES.
8.
Did the taxpayer requesting tax benefits have interest(s) in any other BUSINESS (ES) in MISSOURI that FILE A
YES NO
SINGLE MISSOURI TAX RETURN WITH THIS FACILITY for this tax period? Answer YES only if a single
Missouri return is filed for these businesses.
8a. List names and REIN numbers of other businesses FILING SINGLE MISSOURI RETURN WITH THIS FACILITY.
YES NO
9.
Did the taxpayer of this new or expanded facility operate any other FACILITY (IES) in MISSOURI besides this new
or expanded facility during this tax period?
Answer YES only if a single Missouri return is filed for these facilities.
9a. Lisa names and addresses of all Missouri facilities FILING SINGLE MISSOURI TAX RETURN WITH THIS FACILITY.
THIS PORTION IS TO BE COMPLETED ONLY BY TAXPAYERS CLAIMING ENTERPRISE ZONE TAX BENEFITS. DO NOT COMPLETE IF THIS
FACILITY IS NOT WITHIN AN ENTERPRISE ZONE.
YES NO
10. Excluding local, state or federal government funding sources, did the TAXPAYER incur costs to train employees
AT THIS ENTERPRISE ZONE FACILITY DURING THIS TAX PERIOD? If YES, attach Schedule B. (Trainee must
be zone resident or “difficult to employ.”)
YES NO
11. Were any of THIS FACILITY’S employees residents of a MISSOURI ENTERPRISE ZONE DURING THIS TAX
PERIOD?
If YES, attach Schedule C. (Addresses must be verified by enterprise zone representative(s).)
YES NO
12. Were any of THIS FACILITY’S employees unemployed at least 90 days OR eligible for Temporary Assistance or
the General Relief Program AT THE TIME HIRED FOR THIS DEVELOPMENT?
If YES, attach Schedule D.
Revised 01/2015
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