Form 135 - A - Application For Subsequently Claiming Tax Benefits
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1
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3MISSOURI FORM
135 - A
NEW/EXPANDED BUSINESS FACILITY AND ENTERPRISE ZONE:
APPLICATION FOR SUBSEQUENTLY CLAIMING TAX BENEFITS
Read instructions carefully before completing form.
Schedules S and M must accompany this application which must be filed each year following year one.
FOR CALENDAR
OR TAX YEAR
ENDING
YEAR
BEGINNING
NAME OF FACILITY
FACILITY FEDERAL ID NO.
PLEASE
ADDRESS OF FACILITY (WHERE DEVELOPMENT OCCURRED)
TAXPAYER FEDERAL ID
TYPE
NO.
OR
PRINT
CITY
COUNTY
ZIP CODE
FACILITY MISSOURI TAX
ID NO. (MITS)
MISSOURI
YES NO
1.
Is this address within a designated enterprise zone?
1a. List all other federal and state programs for which this facility is applying, or is currently utilizing:
2.
Name and mailing address if different than above:
NAME
ADDRESS (STREET, PO BOX, CITY, STATE, ZIP CODE)
2a. Name and address of business headquarters, if different from above:
3.
Name, address and telephone of contact person completing application:
NAME
Email Address
TELEPHONE NUMBER
(
)
ADDRESS (STREET, PO BOX, CITY, STATE, ZIP CODE)
4.
Business entity for tax purposes:
4a. Corporation
4b. Fiduciary
4c. Individual
4d. Partnership
Proprietorship
4e. S-Corp.
Limited Liability Corp.
4g. Limited Liability
4h. Other (Specify)
4f.
Partnership
_____________
NOTE: IF THE TAXPAYER IS A FIDUCIARY, PARTNERSHIP, S-CORPORATION, ETC., IDENTIFY THE NAMES, SOCIAL SECURITY
NUMBERS AND PROPORTIONED SHARE OF OWNERSHIP OF EACH BENEFICIARY, PARTNER OR SHAREHOLDER ON THE
LAST DAY OF THE TAX PERIOD. AGGREGATE PROPORTIONATE SHARES OR PERCENTAGE OF TOTAL OWNERSHIP MAY
NOT EXCEED 100%. ATTACH A SEPARATE SHEET IF NECESSARY.
NAME(S)
SOCIAL SECURITY NO.(S)
%OWNERSHIP YEAR END
%
%
%
%
Taxpayer’s total annual Missouri sales revenues or receipts:
4i.
$0 - $250,000
$250,000 - $500,000
$500,000 - $1M
$1M - $5M
$5M - $10M
$10M and
over
Taxpayer’s total Missouri employment (total
4j.
number of employees):
5.
Describe the business activity (ies) conducted at this facility. Be specific.
5a. Enter the facility’s 5-digit NAICS number if known:
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