Form Ur-J - Application For Eligibility - Urban Job Tax Credit Program - Florida Department Of Economic Opportunity Page 8
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9FORM UR-J
Rev. 07/01
(THE FOLLOWING IS REQUIRED OF ALL APPLICANTS)
CREDIT WILL BE TAKEN AGAINST:
CORPORATE;
SALES/USE TAX
If using a Sales & Use Tax Credit, list Sales & Use Tax Certificate #: __ __ - __ __ - __ __ __ __ __ __ - __ __ - __.
P
LEASE PROVIDE INFORMATION ON THE QUALIFIED EMPLOYEES
:
FOR WHOM THE APPLICANT IS CLAIMING A CREDIT
(If necessary attach a separate sheet listing this information.)
EMPLOYEE NAME
S. S. NUMBER
CREDIT
Under penalties of perjury, I declare that I have examined this form including accompanying schedules
and statements, and to the best of my knowledge and belief it is true, correct and complete.
S
R
D
A
C
O
D
IGNATURE OF
EGISTERED
EALER OR
UTHORIZED
ORPORATE
FFICER
ATE
FOR DEPARTMENT USE ONLY
A tax credit of $
is hereby approved for either:
Corporate or
Sales and Use Tax.
(Authorized Signature)
(Date)
C:\Documents and Settings\dev17536\My Documents\Business Development\UJTCP_Application.doc
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