Form Int - Report Of Intent To Invest In Project For Income Tax Capital Credit - 2009

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LABAMA

EPARTMENT OF

EVENUE

_________________________

CONTROL NUMBER

INT

Report of Intent to Invest in Project

_________________________

PROJECT NUMBER ISSUED

for Income Tax Capital Credit

7/09

This form is to serve as the written statement of intent for a capital credit project in accordance with the provisions of

Title 40, Chapter 18, Articles 7 and 9, Code of Alabama 1975. See instructions prior to completing Form INT.

Project entity:

FEIN:

Address:

Telephone No.: (

)

City:

State:

Zip:

Project name:

NAICS code:

Project location (if different from above):

Project filing status:

LLC

C Corporation

S Corporation

Partnership

Estate

Sole Proprietorship

1a. Type of project:

Industrial, Warehousing, or Research Activity

Small Business Addition

Headquarters Facility

Data Processing Center

State Docks

Renewable Energy Facility

Research and Development Facility

Alternative Energy Resources Electricity Production

Hydropower Electricity Production

1b. Is project located in a Favored Geographic Area?

Yes

2. Type of trade or business to be conducted at the project (see instructions):

3. Description of project (attach additional sheets if necessary) (see instructions):

4a. Will project be phased?

Yes

4b. Estimated date project is to be placed in service (if phased, include dates for each phase):

7. Projected number of new

5. Estimated project costs:

employees for this project: . . . . . . . . . . . . . . . . . . . . . .

a. Building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Projected average hourly wage for new

b. Land. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

employees employed by this project: . . . . . . . . . . . . . .

c. Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Enter county where project will be located:

d. Architectural and Engineering . . . . . . . . . . . . . .

e. Landscaping. . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Contact person for capital credit and to whom all correspondence will

f. Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

be sent:

6. Total estimated project costs . . . . . . . . . . . . . . .

11. Election for determination of income earned at the project:

Two Factors (property and payroll)

Three Factors (property, payroll, and sales)

Separate Accounting (see instructions)

12a. Has the investing company reduced its employment level in the last two years?

Yes

12b. Has an investing company in the project closed a facility in Alabama in the last two years?

Yes

No If yes, complete the following:

Date of closure:

No. of employees at the date of closure:

Location of facility:

13. Number of current employees employed in Alabama by investing company prior to project:

Allocations of Capital Credit

A complete list of all participants in the project entity entitled to receive the Capital Credit must be provided. (Attach additional sheets if necessary.)

Name:

Address:

City:

State:

Zip:

City:

State:

Zip:

Social Security No. or FEIN:

Percentage Allocation of Credit:

Under penalties of perjury, I declare that I am duly authorized to complete this form and that I have listed all the participants of the project entity. I have examined the above

statements and to the best of my knowledge and belief they are true, correct, and complete.

Your Signature:

Title:

Date: