Form 89se - Certification For Idaho'S Small Employer Tax Incentives

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89SE
F
CERTIFICATION FOR IDAHO'S
O
R
EFO00044
SMALL EMPLOYER TAX INCENTIVES
M
02-13-13
Federal employer identification number
Business name
Contact person and title
Business mailing address
City, state and zip code
Telephone number of contact person
QUALIFYING FOR THE INCENTIVES
To claim the Idaho small employer incentives, you must certify that you have met, or will meet, the following tax incentive criteria at the
project site during the project period:
1. Capital investment in new plant and building facilities of at least $500,000,
2. Increased employment by at least 10 new employees who each earn at least $19.23 per hour worked and receive health
benefits, and
3. For new employment increases above the 10 new employees, the average wages of the additional new employees is at least
$15.50 per hour worked. See the instructions for who is included in this calculation.
The following information is required to certify that the proposed project will meet the small employer tax incentive criteria during the
project period. Failure to provide the requested information may result in the Tax Commission denying any tax incentives claimed under
the Idaho Small Employer Incentive Act.
1. Description of qualifying project
2. Estimated/actual start date of project. The start date is the earlier of the date the first physical change to the project site
occurs or the date new employees related to the project site are first employed in Idaho. The start date cannot be earlier than
January 1, 2006.
3. Estimated/actual end date of project. The project period cannot be longer than 10 years or end later than December 31, 2020.
4. Location of the project site(s). Identify the street address for each site. If more than one location, identify the percent of the
investment projected at each site once the project is completed.
5. Estimated/actual number of new jobs created during the project period. For each year in the project period, enter the tax
year followed by the number of new jobs created during that year.
Yr_________ # of jobs_________________________
Yr_________ # of jobs_________________________
Yr_________ # of jobs_________________________
Yr_________ # of jobs_________________________
Yr_________ # of jobs_________________________
Yr_________ # of jobs_________________________
Yr_________ # of jobs_________________________
Yr_________ # of jobs_________________________
Yr_________ # of jobs_________________________
Yr_________ # of jobs_________________________
Total # of jobs ________________________

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