Form W-Ra - Required Attachments For Electronic Filing - 2012

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FORM
W-RA
Required
2012
Attachments for
Wisconsin
Electronic Filing
Department of Revenue
Taxpayer Information
( USE BLACK INK ONLY )
Your legal last name
Legal first name
M.I.
Your social security number
If joint return, spouse’s legal last name
Spouse’s legal first name
M.I.
Spouse’s social security number
Legal name of estate, trust, or corporation
FEIN
Address (number and street)
Apt. no.
Daytime phone number
City or post office
State
Zip code
E-mail address
Submit this form only if you electronically filed your return or homestead credit claim.
Attachments –
Check the applicable box(es) to identify the attachments.
Homestead credit (Schedule H or H-EZ) – Attach required documents (W-2s, W-2Gs, 1099-Rs, 1098-Ts, original rent
certificate(s), tax bill(s), legal documents, and statements).
Closing certificate for fiduciaries (Schedule CC) – Estates – Attach a copy of the decedent’s will and the probate
inventory. Trusts – Attach a copy of the trust instrument and three years of accountings.
Amended return (Form 1X) – Attach forms, documents and/or schedules that support the item(s) changed, as needed.
Angel investment credit (Schedule VC) – Attach a copy of the new business venture certification form provided by the
WEDC and the tax credit verification form issued by the WEDC or a copy of your Schedule 3K-1 or 2K-1.
Beginning farmer and farm asset owner credit (Schedule FL) – Attach certificate of eligibility from DATCP or a copy of
your Schedule 5K-1, 3K-1, or 2K-1.
Community rehabilitation program credit (Schedule CM) – Attach signed Part II of Schedule CM or a copy of your
Schedule 5K-1, 3K-1, or 2K-1.
Dairy cooperatives credit (Schedule DM) – Attach Schedules DM and DMK-1.
Dairy manufacturing facility investment credit (Schedule DM) – Attach a copy of your DATCP certification or Schedule
5K-1, 3K-1, or 2K-1.
Development zones credit (Schedule DC) – Attach a copy of your certification to claim tax benefits and the verification of
expenses from WEDC. Also attach a statement from WEDC verifying the amount of credit for environmental remediation
and job creation or retention. If credit is from a pass-through entity, attach Schedule 5K-1, 3K-1, or 2K-1 instead.
Early stage seed investment credit (Schedule VC) – Attach a copy of the certification issued by WEDC to the business
and to the fund manager and a statement from the fund manager containing (1) name and address of the fund manager
and (2) for each investment, the date, total amount of investment, amount invested in a qualified new business venture,
and amount of tax credit or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Economic development credit (Schedule ED) – Attach a copy of your certification and the notice of eligibility to receive
tax benefits from the WEDC or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Electronic medical records credit (Schedule EM) – Attach a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Eligible veterans and surviving spouses property tax credit – Attach real estate tax bill(s) for all taxes paid in 2012, proof
of payment, and your Wisconsin Department of Veterans Affairs certification, if required.
Enterprise zone jobs credit (Schedule EC) – Attach a copy of your certification to claim tax benefits and the verification
of your expenses from WEDC or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Farmland preservation credit (Schedule FC or FC-A) – See the instructions for the schedule you are filing for the
required attachments.
Film production company investment credit (Schedule FP) – Attach a copy of the certification from the Department of
Tourism that the credits claimed are for expenses related to establishing a film production company in Wisconsin or a
copy of your Schedule 5K-1, 3K-1, or 2K-1.
Film production services credits (Schedule FP) – Attach a copy of the approved application from the Department of
Tourism or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
I-041i (R. 10-12)
Refer to instructions on back.

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