Form Fiia-01 - Eligibility Application Page 2
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4W V FO – Form FIIA-01: Eligibility Application
Page 2 of 4
Par t III - PRODUCTION E XPENDITURES
Attach budget top sheet and include dedicated column for estimated West Virginia qualified expenditures. Estimated
WV qualified expenditures must be a minimum of $25,000 for Applicant to be eligible to apply to program. Provide
estimated WV expenditures for each phase of production which are subject of the Eligibility Application.
Total Estimated Budget $ _________________________________________
WV Estimated Budget $ __________________________________________
Tax Credit Requested $ ________________________________
Estimated West Virginia Qualified Expenditure Totals:
Pre-production $ _________________________
Production $ ______________________________
Post-production $ ________________________
Total Principal Photography Days ____________________________________ WV Principal Photography Days ____________________________________
Anticipated date of first expenditure in WV ____________________________
Does Applicant intend to maximize tax credits by hiring 10 or more WV residents –
l Yes
l No
crew or talent – to work full-time during principal photography?
Applicant is also eligible for exemption from state sales tax on certain expenditures.
l Yes
l No
Does Applicant intend to apply for this additional incentive?
If "Yes", Applicant must complete a Direct Pay Permit and submit directly to the WV Tax Department (form available at ).
Par t IV – PRODUCTION SCHEDULE & LOCATIONS
Anticipated Production Schedule
In West Virginia
Total Production
Start Date
End Date
Start Date
End Date
Pre-Production
Production / Principal Photography
Post-Production
Anticipated Release / Premiere Date
Anticipated Locations
Identify WV locations to be used during filming, including cities, addresses, and/or other location details or property identifiers:
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
____________________________________________________________________________
Department Use Only
Date/Time Rec. _____________________________
Received By ________________________________
Application # _______________________________
West Virginia Film Office 90 MacCorkle Avenue, SW • South Charleston, WV 25303 • 866-698-3456 •
Form FIIA-01
9/14/12
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