Form Dtf-619 - Claim For Qetc Facilities, Operations, And Training Credit Page 3

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DTF-619 (2006) Page 3 of 4

Schedule C

(continued)

24a Partner in a partnership - enter your share of the partnership’s

Partner

research and development property credit component . ........................ 24a.

24b S corporation shareholder - enter your share of the S corporation’s

S corporation shareholder

research and development property credit component . ........................ 24b.

24c Beneficiary - enter your share of the estate’s or trust’s research and

Beneficiary

development property credit component . .............................................. 24c.

24d Total research and development property credit component

(add line 23 and lines 24a through 24c)

. ...................................................... 24d.

Fiduciaries — Include the line 24d amount on the Total line of Schedule D, column C, and continue with Part 2.

S corporations — Enter the line 24d amount on Form CT-34-SH, line 45a, and continue with Part 2.

All others — Continue with Part 2.

Part 2 — Qualified research expenses credit component

Description of

Date paid or

Cost

Credit

expense

incurred

(column C × rate of 9% (.09))

(mm-dd-yyyy)

Totals from attached schedule, if needed . ...............................................................

25.

Qualified research expenses credit component amount

(add amounts in column D and enter the total here)

26a Partner in a partnership - enter your share of the partnership’s

Partner

qualified research expenses credit component ..................................... 26a.

26b S corporation shareholder - enter your share of the S corporation’s

S corporation shareholder

qualified research expenses credit component ..................................... 26b.

26c Beneficiary - enter your share of the estate’s or trust’s qualified

Beneficiary

research expenses credit component ................................................... 26c.

26d Total qualified research expenses credit component

(add line 25 and lines 26a through 26c) . ............................................... 26d.

Fiduciaries — Include the line 26d amount on the Total line of Schedule D, column D, and continue with Part 3.

S corporations — Enter the line 26d amount on Form CT-34-SH, line 45b, and continue with Part 3.

All others — Continue with Part 3.

Part 3 — Qualified high-technology training expenditures credit component

Employee name

Social security

Description of qualified

Date paid or

Amount of

Credit (enter the

number

high-technology

incurred

expense

lesser of column E

training expense

or $4,000)

(mm-dd-yyyy)

Total from attached schedule, if needed . ............................................................................................................

Qualified high-technology training expenditures credit component amount

27.

(add amounts in column F and enter the total here)

Please file this original scannable

61903060094

form with the Tax Department.