Form Txl 193 - Jobs Credit Supplemental Information Sheet - City Of Tacoma
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1CITY OF TACOMA
Finance Department / Tax & License Division
Jobs Credit Supplemental Information Sheet
Chapter 6B of the Tacoma Municipal Code, as amended.
City of Tacoma Contract Acct # ______________________________State Employer ID# _________________________________
Check one:
Individual
❏
Corporation
❏
Partnership
❏
LLC
❏
1. Name of Owner, Partnership, Corporation or LLC: _____________________________________________________________
2. Name of Business (DBA): ________________________________________________ Phone #: __________________________
Tacoma
WA
3. *Business Physical Location:_________________________________________________________________________________
Street Address
City
State
Zip
Your business must be located in the City limits of Tacoma to qualify for the credit.
4. Mailing Address: __________________________________________________________________________________________
Street Address
City
State
Zip
You must maintain records that show the growth in your employment base in Tacoma.
5. ________Number of full time employees at Tacoma location last year: ____________________
(Date)
6. ________Number of full time employees at Tacoma location prior to new position: _____________________
(Date)
7. ________Number of full time employees at Tacoma location including new position: ___________________
(Date)
A new application must be completed for each new position added.
8. New Position Information:
Date new position filled: ________
Job title (position):
Hourly rate paid: ________“Family Wage” compensation must be attained within 12 months of hire date.
Number of hours worked per week: _______
9. Will you keep the new permanent full time position for at least five years?
❏
Yes
❏
No
Note: You must keep the new position for the entire five year period. For vacancies you have three months to refill the
position without a reduction and/or repayment of the credit.
Signature of Applicant: _____________________________________________________ Date: ______________________
* If you add the new job to your workforce in Tacoma within the empowerment zone or “distressed areas”—areas of high
poverty and unemployment—as defined by the Washington State Department of Revenue and do business in international
services, you may be eligible for an extra $250 tax credit every year for five years. For more information, call Revenue’s
Telephone Information Center at 1-800-647-7706.
Computation of Credit Example with 10 New Positions Hired:
10 X $500 = $5,000 annual (calendar year) credit for five years.
The credit cannot be accrued and carried back or forward between years.
Positions filled after June 30
qualify for only a half credit of $250 for the first calendar year.
th
City of Tacoma • Finance Department / Tax & License Division • 733 Market Street, Rm. 21
Tacoma, WA 98402-3770 • Phone (253) 591-5252 • FAX (253) 591-5512
TXL 193 (03/05) a
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