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Wv/bcs-Small - West Virginia Small Business Investment And Jobs Expansion Tax Credit Page 26

Taxable year beginning ______________________, Ending _______________________

NAME

IDENTIFICATION NUMBER

PART VIII - ADDITIONAL REQUIRED INFORMATION

1. Was there a premature disposition of any qualified investment property, owned or leased by the taxpayer, during the

taxable year?

Yes

If the answer is yes, attach a schedule identifying the property; date it was acquired; date of its disposition; its cost; the

amount of qualified investment allowed with respect to such property and the reason for the disposition of the property

before the end of the 4th, 6th, 8th or 10th year, as appropriate.

2. Was the new or expanded business facility, for which credit was allowed, sold or otherwise conveyed to another person

or legal entity during the taxable year?

Yes

(a) If yes, identify the new business, name, mailing address, and identification number, if either is different from that

listed on the front of the tax return with which this schedule is filed.

(b) Was this a mere change in form of doing business?

Yes

Date of transfer or sale:

Name of new owner:

Mailing address of new owner:

Identification number:

(d) Is credit being claimed with respect to a certified project?

Yes

3. Has an application for certification of the project been filed with and approved by the West Virginia Tax

Commissioner?

Yes

(a) If no, credit is not allowable for a certified project.

(b) If yes, identify the name of each participant in the project; location of the project's primary qualified investment

and your share of the project's credit.

Participants' Names

Primary Location of Project

Share of Project's Credit

the taxable year?

Yes

If yes, identify the property and the names of the project participant who owned or leased it.

Project's qualified investment property:

Wv/bcs-Small - West Virginia Small Business Investment And Jobs Expansion Tax Credit Page 26