Form K-59 - High Performance Incentive Program (Hpip) Credits Page 2

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12. Enter your ownership percentage. See instructions.
12. ________________ %
13. Amount of current year credit available (multiply line 11u by 12)
13. __________________
13a. Prior year(s) carry forward
13a. __________________
13b. Total credit available this tax year (add lines 13 and 13a)
13b. __________________
14. Amount of tax liability for current year after all previous claimed credits
14. __________________
15. Amount of credit used
15. __________________
16. Amount of carry forward for next year’s Schedule K-59
16. __________________
PART D — NEW INVESTMENT INFORMATION
17. Number of actual jobs created as a direct result of this qualified business facility investment.
17. __________________
18. Additional payroll generated as a direct result of actual jobs created on line 17
18. __________________
19. Actual number of jobs retained that would have been eliminated if not for this qualified business
facility investment
19. __________________
20. Payroll for actual jobs retained on line 19
20. __________________
21. Additional revenue or loss generated as a direct result of this qualified business facility investment.
21. __________________
22. Additional sales generated as a direct result of this qualified business facility investment
22. __________________
23. Total employment in the state of Kansas
23. __________________
24. Total payroll in the state of Kansas
24. __________________
PART E — CARRY FORWARD SCHEDULE
25. First Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
26. Second Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
27. Third Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
28. Fourth Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
29. Fifth Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
30. Sixth Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
31. Seventh Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
32. Eighth Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
33. Ninth Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
34. Tenth Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
Lines 35 through 40 are to be used for HPIP carry forward on UNEXPIRED credits where the investments were placed into
service in taxable years commencing after December 31, 2000.
35. Eleventh Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
36. Twelfth Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
37. Thirteenth Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
38. Fourteenth Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
39. Fifteenth Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________
f. Credit Fwd Available ___________
40. Sixteenth Year
a. Tax Year ______________
b. Certification No. ________________
c. Certification Date ______________
Carry Forward
d. Carry Fwd Amt _________
e. Credit Used ___________________

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