Form 135 - New/expanded Business Facility (Headquarters): Application For Initially Claiming Tax Benefits - State Of Missouri Page 4

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NEW/EXPANDED BUSINESS FACILITY (HEADQUARTERS):
CURRENT EMPLOYMENT WORKSHEET
Read instructions carefully before completing form.
FOR CALENDAR Y EAR
OR TA X Y EAR BEGINNING
ENDING
THIS FORM IS REQUIRED TO VERIFY SCHEDULE S. This listing should include all employees located at the facility and may be
submitted in an Excel spreadsheet. Send electronically to dedfin@ded.mo.gov, noting that the list is intended for use with the Business
Facility Credit program.
Last 4 digits of
SSN or
Date
Average hours worked
Name (Last, First)
Employee ID #
Hired
per week
Taxpayer’s or Designee’s Signature
Date
Preparer’s Signature
Date
Updated 01/2015

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