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MoDED 135

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ONLY

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19a. If yes, describe the commercial operations at the OTHER FACILITY(IES). BE SPECIFIC.

19a

19b. Enter the Standard Industrial Classification (SIC) number(s) of the OTHER FACILITY(IES) if known: - - -

19b

0 yes

Lit

KNOWLEDGE

MO419-1524 (12-95)

PAGE 3

14. Did the taxpayer requesting tax benefits have interest(s) in any other BUSINESS(ES) in MISSOURI that FILE A SINGLE

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

IS FILED FOR THESE BUSINESSES (See instructions, page 7).

14a List names and FEIN numbers of other businesses FILING SINGLE MISSOURI RETURN WITH THIS FACILITY:

14a

15. 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 instructions, page 7).

THIS PORTION 1s

X P A Y E

N G E N T E

. ~0 NOT

TO BE COMPLETED

BY TA

R S

L A I M I

R P R I

E Z O N E T A X B E N E F I T S

COMPLETE IF THIS FACILITY IS NOT WITHIN AN ENTERPRISE ZONE.

16.

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

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

17. Were any of THIS FACILITY’ S employees residents of THIS ENTERPRISE ZONE DURING THIS TAX PERIOD? IF YES, ATTACH

SCHEDULE C. (See instructions, page 7: addresses must be verified by enterprise zone representative)

yes

18. 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? IF YES, ATTACH SCHEDULE D.

(See instructions, page 7)

THlS PORTION IS TO BE COMPLETED ONLY BY TAXPAYERS CLAIMING NEW OR EXPANDED BUSINESS FACILITY TAX

BENEFITS. DO NOT COMPLETE IF THIS FACILITY IS WITHIN AN ENTERPRISE ZONE.

19. At the time of commencement, or immediately prior to commencement of this expansion, addition, or replacement, did

the taxpayer operate ANY OTHER MISSOURI facility(ies), in addition to the new or expanded facility?

yes

(See instructions, page 7)

20. Does the taxpayer elect to defer claiming this credit? (See instructions, page 7)

20a If yes, to what tax year is credit deferred--may be deferred up to three additional tax periods (See instructions, page

7): Tax Period Ending (Month, Day and Year)

20a

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

AND

ACCOMPANYING SCHEDULESAND STATEMENTS, AND TOTHE BESTOF MY

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 85102.

SCHEDULES S AND M MUST ACCOMPANY THIS APPLICATION

NOTE: THIS APPLICATION MUST BE FILED IN THE TAX PERIOD AFTER THE COMMENCEMENT TAX

PERIOD (see date Item 13).

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

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

Form 135 - New/expanded Business Facility And Enterprise Zone: Application For Initially Claiming Tax Benefits - State Of Missouri Page 3

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