Form Dtf-619 - Claim For Qetc Facilities, Operations, And Training Credit - 2011
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4DTF-619
New York State Department of Taxation and Finance
Claim for QETC Facilities,
Operations, and Training Credit
Tax Law — Articles 9-A and 22
All filers must enter tax period:
beginning
ending
Taxpayer identification number
Name(s) as shown on return
File this form with corporate franchise tax return Form CT-3, CT-3-A, or CT-3-S or with personal income tax return Form IT-201, IT-203,
IT-204, or IT-205.
(See instructions, Form DTF-619-I, for assistance.)
Mark an X in the box for the tax year for which you are claiming the qualified emerging technology company (QETC) facilities, operations,
or (only if relocating from incubator facility) 5
and training credit on this form:
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Line A — Partner in a partnership, S corporation shareholder, or beneficiary of an estate or trust.
Business name
Taxpayer identification number
Schedule A — QETC eligibility requirements
(All the questions in Schedule A pertain to the tax year for which you are claiming the credit.)
Part 1 — Location and sales
(Mark an X in the appropriate boxes.)
1 Is the company located in New York State? ................................................................................................ Yes
No
2 Are the total annual product sales of the company $10,000,000 or less? ................................................... Yes
No
If you answered Yes to questions 1 and 2, continue with Part 2.
If you answered No to either question 1 or 2, stop. You cannot claim this credit for the current tax year.
Part 2 — QETC business activities
Primary products and services
3 Does the company develop or create products or services that are classified as emerging technologies? .. Yes
No
If Yes, enter in the box below a description of the company’s emerging technology products or services, and continue with line 4.
If No, stop. You cannot claim this credit.
4 Enter the gross receipts or sales from all the company’s products or services included
on your federal return .............................................................................................................
4.
If line 4 is zero, skip lines 5 through 7 and continue with line 8. If line 4
is greater than zero, continue with line 5.
5 Enter the gross receipts or sales from the company’s emerging technology products or
services described on line 3 included on your federal return ................................................
5.
6 Divide line 5 by line 4
6.
%
...........................................................
( round the result to the fourth decimal place )
7 Is the percentage on line 6 greater than 50%? ............................................................................................... Yes
No
If Yes, continue with Schedule B.
If No, and line 4 is greater than zero, stop. You cannot claim this credit.
8 Enter the total expenditures attributable to the development or creation of emerging
technology products or services included on your federal return ..........................................
8.
9 Enter the total expenditures included on your federal return .....................................................
9.
10 Divide line 8 by line 9
............................................................ 10.
%
(round the result to the fourth decimal place)
11 Is the percentage on line 10 greater than 50%? ............................................................................................. Yes
No
If Yes, continue with Schedule B. If No, stop. You cannot claim this credit.
6191110094
Please file this original scannable
form with the Tax Department.
61901110094
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