Form 135 - Application For Initially Claiming Tax Benefits (Page 4 of 4) in pdf

Form 135 - Application For Initially Claiming Tax Benefits Page 4

MoDED 135

PAGE 4

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I hereby agree to allow representatives of the Department of Economic Development access to the property and applicable

records as may be necessary for the administration of this program.

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I certify under penalties of perjury that the above statements, information contained in the application and attachments are com-

plete, true, and correct to the best of my knowledge and belief.

MUST BE SIGNED IN PRESENCE OF NOTARY:

_______________________________________________________

SIGNATURE OF TAXPAYER OR AUTHORIZED REPRESENTATIVE

STATE OF MISSOURI

)

) ss.

COUNTY/CITY OF __________________ )

On this _____ day of _______________, 200__, before me, ___________________________, a Notary Public in and for said state,

personally appeared __________________________, known to me to be the person who executed the Certification and acknowl-

edged and states on his/her oath to me that he/she executed the same for the purposes therein stated.

_____________________________________________________

Notary Public

(SEAL)

My commission expires __________________________________

MAIL ALL CLAIMS FOR TAX BENEFITS AND ALL RELATED INQUIRIES TO: FINANCIAL SERVICES SECTION, MISSOURI

DEPARTMENT OF ECONOMIC DEVELOPMENT, P.O. BOX 118, JEFFERSON CITY MO 65102.

SCHEDULES S AND M MUST ACCOMPANY THIS APPLICATION.

NOTE: THIS APPLICATION MUST BE FILED IN THE TAX PERIOD AFTER THE COMMENCEMENT TAX PERIOD (see date

Item 13).

THIS APPLICATION MUST BE FILED WITH THE DEPARTMENT OF ECONOMIC DEVELOPMENT FOR CREDIT CERTIFICA-

TION PRIOR TO CLAIMING THE BENEFITS ON YOUR MISSOURI TAX RETURN.

MO 419-1524 (11-04)

Form 135 - Application For Initially Claiming Tax Benefits Page 4