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ORWORKlNGinthezoneDURlNGTHlSTAXPERIOD.Iftheemployee

DURINGTHISTAXPERIOD. Enterthemonth,dayandyeartheemploy

M0419-1524 (12-95)

-14-

SOCIAL SECURITY NO.

For the purpose of this credit, the employee MUST HAVE BEEN HIRED

Enter each employee/resident’ s social security number in the space

NO EARLIER THAN THREE MONTHS PRIOR TO THE COMMENCE-

provided.

MENT DATE entered above and on Line (13) of Form 135: THE

EMPLOYEE MUST HAVE BEEN HIRED FOR THIS SPECIFIC

RESIDENTS’ ADDRESSES

DEVELOPMENT (OR LATER).

RESIDENT ADDRESSES MUST BE WITHIN THIS ENTERPRISEZONE

Enter the FULL name of employees meeting the following criteria:

WHERE THIS FACILITY IS LOCATED.

1) at the time the employee was hired by you at this facility, he/she

RESIDENT ADDRESSES MUST BE VERIFIED BY THE LOCAL

had been UNEMPLOYED FOR AT LEAST 3 MONTHS; OR

ENTERPRISE ZONE COORDINATOR.

2) at the time the employee was hired by you at this facility, he/she

Enter the enterprise zone address of the employee/resident. INCLUDE

was ELIGIBLE FOR THE GENERAL RELIEF PROGRAM or AID TO

house or apartment NUMBERS AND NAME OF STREET OR rural

FAMILIES WITH DEPENDENT CHILDREN (AFDC); and

ROUTE NUMBERS, CITY, STATE, and ZIP CODES.

3) the employee was hired NO SOONER THAN THREE MONTHS

DO NOT USE POST OFFICE BOX OR DRAWER NUMBERS.

PRIOR to the date when the new or expanded portion of this facility

THE LOCAL GOVERNING AUTHORITY OR AUTHORIZED REPRE-

started commercial operations (see COMMENCEMENT DATE OF

SENTATIVE OF THE ENTERPRISE ZONE MUST VERIFY THESE

OPERATIONS above); and

ADDRESSES ARE WITHIN THIS ZONE BY SIGNING THIS SCHE-

4) the employee was hired AFTER THE DATE when this enterprise

DULE. (See map, page 5 for local enterprise zone contact numbers.)

ZONE WAS initially DESIGNATED OR subsequently EXPANDED (see

PERIOD OF RESIDENCY

designation date entered on Schedule A); and

Enter the dates when the employee lived in THIS ENTERPRISE ZONE

5) the employee WORKED AT THIS FACILITY DURING THIS TAX

WHERETHIS FACILITY IS LOCATED. The residency must be DURING

PERIOD; and

THIS TAX PERIOD. Enter the month, day and year the employee

6) the employee was hired to work FULL TIME, OR an AVERAGE OF

INITIALLY LIVED AND WORKED in the zone DURING THIS TAX

20 HOURS PER WEEK, OR 80% OF THE facility’ s SEASON (if any).

PERIOD, and the month, day and year the employee ENDED LIVING

EMPLOYMENT DATE

lived in the zone the entire tax period, enter “ l/1/95-12/31/95” for

Enter the month, day and year the employee WAS INITIALLY HIRED

at this facility.

residency dates.

IF THE SPECIFIC DATES (month, day, year) ARE NOT PROVIDED,

For the purpose of this credit, the employee MUST HAVE BEEN HIRED

NO EARLIER THAN THREE MONTHS PRIOR TO THE COMMENCE-

CREDITS WILL BE REDUCED OR DISALLOWED.

MENT DATE entered above and on Line (13) of Form 135: T H E

SIGNATURE

EMPLOYEE MUST HAVE BEEN HIRED FOR THIS SPECIFIC

An unsigned application, form or schedule

invalid. The taxpayer

DEVELOPMENT (OR LATER).

claiming these tax benefits OR HIS DESIGNEE, AND THE ENTER-

SOCIAL SECURITY NO.

PRISE ZONE COORDINATOR, must sign and date all applicable

Enter each special employee’ s social security number in the space

documents, subject to the penalties of perjury.

provided.

“ DIFFICULT TO EMPLOY”

SCHEDULE D INSTRUCTIONS

The term “ difficult to employ” means ONLY those employees, who

ENTERPRISE ZONE: SPECIAL EMPLOYEE CREDITS

at the time they were hired at this facility for the new development,

WERE UNEMPLOYED AT LEAST 3 MONTHS. If the employee meets

this criteria, enter “ yes.”

NOTE: DO NOT COMPLETE THIS SCHEDULE IF THIS FACILITY

IS NOT IN AN ENTERPRISE ZONE.

RELIEF OR AFDC SUBSIDIES

Employees who were ELIGIBLE for Missouri’ s General Relief Program,

READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS

or Aid to Families with Dependent Children (AFDC), AT THE TIME

FORM AND ANSWER ALL QUESTIONS, OR THE CERTIFICATION

THEY WERE HIRED at this facility, are eligible for special employee

WILL BE DELAYED.

credits. If the employee meets this criteria, enter “ yes.”

THIS SCHEDULE OR SCHEDULE C MUST BE COMPLETED TO

If both columns have been checked “no,” the employer is NOT

VERIFY TAXPAYER’ S “30%” ELIGIBILITY.

ELIGIBLE to claim special employee credits for the employee.

TAX PERIOD

LENGTH OF UNEMPLOYMENT

Enter the tax period for which these tax benefits are being claimed.

HOW/WHY ELIGIBLE FOR SUBSIDIES

DO NOT FILE BEFORE THE END OF THE TAX PERIOD. The tax

If applicable, enter the SPECIFIC DATES the employee was UNEM-

credits are claimed for the year they are earned.

PLOYED prior to the time you hired him/her, e.g. “ l/1/95-4/1/95” : THIS

A separate Schedule D must be filed for each tax period special

PERIOD MUST BE AT LEAST 3 MONTHS. OR, if applicable, specifically

employee credits are claimed.

DESCRIBE HOW OR WHY THE EMPLOYEE WAS ELIGIBLE for the

General Relief Program or Aid to Families With Dependent Children

NAME

(AFDC) AT THE TIME you HIRED him/her, e.g. “ no income” ; “ employee

Enter the name of this facility.

was disabled for 4 months prior to being hired,” etc.

COMMENCEMENT DATE OF OPERATIONS:

VERIFICATION MAY BE REQUIRED.

Enter the month, day and year this facility INITIALLY QUALIFIED

for these credits (see Line 13, Form 135).

PERIOD OF EMPLOYMENT

Enter the dates when the employee WORKED AT THIS FACILITY

NOTE: EMPLOYEES MUST HAVE BEEN HIRED NO EARLIER THAN

3 MONTHS PRIOR TO THIS DATE.

BEGAN WORK at this facility DURING THIS TAX PERIOD, and the

IDENTIFICATION

NUMBERS

month, day and year the employee ENDED WORKING at this facility

Enter the FACILITY’ S Federal Employer Identification (FEIN) number,

DURING THIS TAX PERIOD. If the employee worked at the facility

the TAXPAYER’ S FEIN number ONLY IF DIFFERENT, and the

the entire tax period, enter “ l/1/95-12/31/95” for employment dates.

FACILITY’ S Missouri Tax Identification Number.

THE EMPLOYEE MAY NOT HAVE BEEN HIRED MORE THAN 3

ALPHABETICAL LIST OF SPECIAL EMPLOYEES’ NAMES

MONTHS PRIOR TO THE COMMENCEMENT DATE OF OPERA-

This list must be ALPHABETICAL BY LAST NAME.

TIONS (see date above).

Form 135 Instructions - New/expanded Business Facility And Enterprise Zone: I Application For Initially Claiming Tax Benefits Page 9

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