Arizona Form 345 - Credit For New Employment - 2012

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ARIZONA FORM

345

2012

Credit for New Employment

For the calendar year 2012 or

M M D D Y Y Y Y

ﬁ scal year beginning

and ending

Attach to your return.

Name(s) as shown on Form 140, 140PY, 140NR, 140X, 120, 120A, 120S, 120X, or 165

Social security or employer identification number

Part I

Business Information

1 Business name ....................................................................................

2 Business location address ...................................................................

3 Employer identification number ...........................................................

4a What type of entity is the business?

corporation

limited liability company (LLC)

partnership

S corporation

sole proprietorship

4b If the business is an LLC, what is the federal tax classification?

corporation

disregarded entity

partnership

S corporation

If the business is an LLC, a partnership or an S corporation, attach a schedule that lists ownership information including: name, address, TIN,

and ownership percentage at the end of the tax year.

Part II

Qualification for Credit and Credit Calculation

5 Did you receive a Certification from Arizona Commerce Authority? .....................................

Yes

If “Yes”, attach a copy of the Certification. If “No”, skip lines 6 through 9.

(a)

(b)

Number of

Available Credit:

Employees

Multiply column (a) by $3000.

Credit for employees in first year or partial year of employment in a qualified

employment position..........................................................................................................

Credit for employees in the second year of continuous employment in a qualified

employment position..........................................................................................................

Credit for employees in the third year of continuous employment in a qualified

employment position..........................................................................................................

Subtotal: Add lines 6 through 8 in each column, and enter the total ................................

Part III

Qualification for Credit and Credit Amount Passed Through From Partnerships

10 Did a partnership from which you are claiming a pass through credit for new employment

receive Certification from the Arizona Commerce Authority? .................................................

Yes

If “Yes”, attach a copy. If “No”, skip lines 11 through 15.

11 Enter the name of the partnership that received the Certification from the Arizona Commerce

Authority and its identification number. Be sure to attach a copy of the Certification.

Name:

TIN:

12 Enter your share of the credit for employees in first year or partial year of employment in a qualified

employment position ..........................................................................................................................................................

13 Enter your share of the credit for employees in the second year of continuous employment in a qualified

employment position ..........................................................................................................................................................

14 Enter your share of the credit for employees in the third year of continuous employment in a qualified

employment position ..........................................................................................................................................................

15 Subtotal: Add lines 12 through 14, and enter the total ......................................................................................................

Continued on page 2

ADOR 11149 (12)