Form 135 - Application For Initially Claiming Tax Benefits printable pdf download

MISSOURI DEPARTMENT OF ECONOMIC DEVELOPMENT

MISSOURI FORM

135

NEW/EXPANDED BUSINESS FACILITY AND ENTERPRISE ZONE:

APPLICATION FOR INITIALLY CLAIMING TAX BENEFITS

READ PAGES 14-18 OF INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORM

SCHEDULES S AND M MUST ACCOMPANY THIS APPLICATION WHICH

MUST BE FILED IN TAX PERIOD AFTER DEVELOPMENT OCCURRED

FOR CALENDAR YEAR _____ OR TAX YEAR BEGINNING _________________ _____, _____, ENDING _________________ _____, _____

NAME OF FACILITY

FACILITY FEDERAL I.D. NO.

AND

PLEASE

ADDRESS OF FACILITY (WHERE DEVELOPMENT OCCURRED)

STREET

TAXPAYER FEDERAL I.D. NO.

TYPE

AND

CITY

COUNTY

ZIP CODE

FACILITY MISSOURI TAX I.D. NO.

(MITS)

MISSOURI

❿ If yes, attach Schedule A

1. Is this address within a designated enterprise zone? (See instructions, page 14)

Yes

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 (See instructions, page 14):

NAME

ADDRESS (STREET, P.O. BOX, CITY, STATE, ZIP CODE)

2a. Name and address of business headquarters if different from above (See instructions, page 14):

__________________________________________________________________________________________________________________

3. Name, address and telephone of person completing application (See instructions, page 14):

NAME

TELEPHONE NUMBER

(

)

ADDRESS (STREET, P.O. BOX, CITY, STATE, ZIP CODE)

4. Business entity for tax purposes (See instructions, page 14):

4a.

Corporation

4b.

Fiduciary

4c.

Individual Proprietorship

4d.

Partnership

4e.

S-Corp.

4f.

Limited Liability Corp.

4g.

Limited Liability Partnership

4h.

Other (Specify) __________

NOTE: IF THE TAXPAYER IS A FIDUCIARY, PARTNERSHIP, S-CORPORATION, ETC., IDENTIFY THE NAMES, SOCIAL SECURITY NUMBERS AND PROPOR-

TIONED SHARE OF OWNERSHIP OF EACH BENEFICIARY, PARTNER OR SHAREHOLDER ON THE LAST DAY OF THE TAX PERIOD. AGGREGATE PROPOR-

TIONATE SHARES OR PERCENT OF TOTAL OWNERSHIP MAY NOT EXCEED 100%. ATTACH A SEPARATE SHEET IF NECESSARY.

NAME(S)

SOCIAL SECURITY NO.(S)

% OWNERSHIP YEAR END

–

4i. Taxpayer’s total annual Missouri sales revenues or receipts (See instructions, page 14):

$0 - $250,000

$250,000 - $500,000

$500,000 - $1M

$1M - $5M

$5M - $10M

$10M & over

4j. Taxpayer’s total Missouri employment (See instructions, page 14): __________

5. Describe the business activity(ies) conducted at this facility. Be specific. (See instructions, page 14):

5a. Enter the facility’s 4-digit Standard Industrial Classification (SIC) or 5-digit NAICS number if known (See instructions, page 15): __________

6. Which one of the following BEST describes the facility where the development occurred? (See instructions, page 15)

(CHECK ONLY ONE):

6a. A new facility (recently organized and formed)

6b. A new facility to Missouri (relocation or expansion from another state)

6c. A new facility that replaces an “old” facility closed by the CURRENT TAXPAYER

6d. A new facility in addition to another or other OPEN AND OPERATING Missouri facilities

6e. An expansion of an existing facility (attached to an existing structure)

6f.

An expansion of an existing facility (separated from existing structure(s) but on same site)

MO 419-1524 (11-04)

MoDED-135

Form 135 - Application For Initially Claiming Tax Benefits

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