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DTF-620 (9/12) (back)

18 Enter the total expenditures attributable to the development or creation of emerging technology

products or services included on your federal return ................................................................................... 18.

19 Enter the total expenditures included on your federal return ........................................................................... 19.

20 Divide line 18 by line 19

................................................................... 20.

(round the result to the fourth decimal place)

21 Is the percentage on line 20 greater than 50%? ......................................................................................... Yes

If you answered Yes, you are eligible to be certified as a QETC under Category 1. Sign the application in the certification area

and mail it to the address shown below. If you answered No, complete lines 22 through 26 to determine if you are eligible to be

certified under Category 2.

Category 2 — Research and development (R&D) activities

22 Does the company have R&D activities in New York State? ...................................................................... Yes

23 Enter the amount of R&D funds ....................................................................................................................... 23.

24 Enter the amount of net sales

;

( if you have any amount of R&D funds, but zero net sales, you are a QETC

...................................................................................................... 24.

skip line 25 and mark the Yes box on line 26 )

25 R&D funds percentage

................................................. 25.

( divide line 23 by line 24 and enter result as a percentage )

26 Does the percentage on line 25 equal or exceed the applicable percentage for the certification period

for which you are applying

? ........................................................................................... Yes

(see instructions)

If you answered Yes to questions 22 and 26, you are eligible to be certified as a QETC under Category 2. Sign the application in

the certification area and mail it to the address shown below.

If you failed to qualify under Category 1, and answered No to either question 22 or 26 in Category 2, you are not eligible to be certified

as a QETC and should not file this application.

Certification

I declare that to the best of my knowledge and belief this application is correct and complete. I understand that a willfully false

representation is a crime punishable under section 1801 of the New York State Tax Law and sections 175.35 and 210.45 of the Penal Law.

Signature of authorized person

Title

Date

NYS TAX DEPARTMENT

Mail the application to:

CORPORATION TAX REGISTRATION UNIT

W A HARRIMAN CAMPUS

ALBANY NY 12227

Need help?

Telephone assistance

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Business Tax Information Center:

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(518) 457-5431

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Form Dtf-620 - Application For Certification Of A Qualified Emerging Technology Company Page 2

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