Application Form For West Virginia Economic Opportunity Tax Credit For Investments Placed In Service On Or After January 1, 2003 - West Virginia State Tax Department
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1
2Application for West Virginia Economic Opportunity Tax Credit For Investments
WV/EOTC-A
Org. 12/03
Placed In Service On Or After January 1, 2003
Name
Identification Number
Business Name
Tax Year
,
to
,
Street Address
City, Town, or Post Office
State
Zip Code
Application is hereby made to the Tax Commissioner of West Virginia for allowance of Economic Opportunity
Tax Credit with respect to qualified investment property place in service or use during Applicant’s tax year
ending
, and the new jobs created by the Applicant that are directly attributable to the qualified
investment property and that are filled by persons who are domiciled in this State.
1a.
Application Status (Check Only One):
One Year Investment, One Taxpayer
a.)
Multiple Year Investment, One Taxpayer - Must receive Certification From Tax Commissioner
b.)
1b.
Type of Credit:
Regular Credit
Headquarters Relocation
Small Business
2a.
Investment:
Total Investment
Qualified Investment
(1)
Year
Amount $
$
(2)
Year
Amount $
$
(3)
Year
Amount $
$
2b.
Locations(s) of Investment in West Virginia
2c.
General Description of Qualified Investment:
Narrative:
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