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Form 135-A - New/expanded Business Facility And Enterprise Zone: Application For Subsequently Claiming Tax Benefits Page 2

MoDED 135-A

A?JY LEASED LAND, BUILDING(s), MACHINERY, EQUIPMENT, FURNITURE, FIXTURES AND ANY OTHER TANGIBLE

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7 If this new or expanded facrlity was leased from another person(s), enter the net MONTHLY rental/lease cost INCLUDE

PERSONAL DEPRECIABLE PROPERTY IN USE EXCEPT INVENTORIES (See rnstructions, page 8): $

- -

8. Old the taxpayer requestrng tax benefits have tnterest(s)‘ rn any other BUSINESS(ES) In MISSOURI that FILE A SINGLE

MISSOURI TAX RETURN WITH THIS FACILITY for this tax perrod? ANSWER “ YES” ONLY IF A SINGLE MISSOURI RETURN

IS FILED FOR THESE BUSiNESSES (See rnstructrons, page 8).

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8a List names and FEIN numbers of other businesses FILING SINGLE MISSOURI RETURN WITH THIS FACILITY.

9. Did the taxpayer of this new or expanded facility operate any other FACILITY(IES) in MISSOURI besides this new or

expanded facility during this tax period? ANSWER “ YES ONLY IF A SINGLE MISSOURI RETURN IS FILED FOR THESE

FACILITIES (See instructrons, page 8).

THIS PORTION IS TO BE COMPLETED ONLY BY TAXPAYERS CLAIMING ENTERPRISE ZONE TAX BENEFITS. DO NOT

COMPLETE IF THIS FACILITY IS NOT WITHIN A ZONE.

10. Excluding local, state or federal government funding sources, did the TAXPAYER Incur costs to train employees AT THIS

ENTERPRISE ZONE FACILITY DURING THIS TAX PERIOD? IF YES, ATTACH SCHEDULE B. (See Instructions, page

8: trainee must be resident or “ difficult to employ.“ )

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11. Were any of THIS FACILITY’ S employees resrdents of THIS ENTERPRISE ZONE DURING THIS TAX PERIOD? IF YES,

A T T A C H S C H E D U L E C . ( S e e tnstructrons, page 8: addresses

m u s t b e v e r i f i e d b y enterprrse z o n e

no 11

12. Were any of THIS FACILITY’ S employees unemployed at least 90 days OR eligible for AFDC or the General Relief Program AT

THE TIME HIRED for this development who were still employed durmg this tax period? IF YES, ATTACH SCHEDULE D.

(See rnstructrons, page 8)

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UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS APPLICATION, INCLUDING

ACCOMPANYING SCHEDULES AND STATEMENTS, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF,

THEY ARE TRUE, CORRECT, AND COMPLETE.

TAXPAYER’ S OR DESIGNEE’ S SIGNATURE

DATE

PREPARER’ S

SIGNATURE

DATE

MAIL ALL CLAIMS FOR TAX BENEFITS AND ALL RELATED INQUIRIES TO: TAX BENEFIT PROGRAMS,

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

SCHEDULES S AND M MUST ACCOMPANY THIS APPLICATION

THESE APPLICATIONS MUST BE FILED WITH THE DEPARTMENT OF ECONOMIC DEVELOPMENT FOR

CREDIT CERTIFICATION PRIOR TO CLAIMING THE BENEFITS ON YOUR MISSOURI TAX RETURN.

MO 419-1524 (12-95)

SAMPLE FORM PAGE 21

Form 135-A - New/expanded Business Facility And Enterprise Zone: Application For Subsequently Claiming Tax Benefits Page 2

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