Reset Form
Rev. 7/14
Ohio Development Services Agency Grant Request
7.5%-13.5% Grant for Purchases of New Manufacturing Machinery
and Equipment for the Taxpayer’s Taxable Year Ending in 2014
Schedule A – Taxpayer Requesting the Grant –
For the taxable year ending in 2014, the taxpayer (or taxpayers – if the taxpayers
are C corporations and members of a “qualifying controlled group”) identifi ed below hereby requests a nonrefundable grant for purchases
of new manufacturing machinery and equipment in the amounts shown. Enclose this form with the income tax return of the taxpayer
claiming the grant for the taxpayer’s taxable year ending in 2014.
Name of Taxpayer Requesting
Taxpayer’s
Grant Requested on
the Taxpayer’s Return
the 7.5%-13.5% Manufacturer’s Grant
Identifi cation Number
for the Taxable Year
If the taxpayer claiming the grant is an individual, enter the taxpayer’s name
If the taxpayer requesting
Ending in 2014
followed by the letter “I” in the box provided. If the taxpayer claiming the grant is
the grant is an individual,
Enter here and on the
a pass-through entity fi ling a composite return on behalf of the entity’s investors,
enter the taxpayer’s Social
appropriate line of the
enter the pass-through entity’s name followed by the letter “P.” If an estate,
Security number. If the
taxpayer’s income tax.
by “E.” If a trust, by “T.” If the taxpayer claiming the grant is a C corporation,
taxpayer requesting the
enter the taxpayer’s name followed by the letter “C.” If the taxpayer is a C
grant is a C corporation or
corporation and a member of a qualifying controlled group of corporations
a pass-through entity fi ling a
required to compute a consolidated grant, list the name, FEIN and requested
composite return, enter the
grant amount for each member of the qualifying controlled group claiming the
taxpayer’s FEIN.
grant (attach an additional sheet if necessary).
1.
2.
3.
4.
5.
Total grant requested for the taxpayer’s taxable year ending in 2014 (from Schedule B).
Schedule B – The Taxpayer’s 1/7 Grant Amounts Shown by Purchase Year
The Total Requested Grant on Schedule A, Line 5 Consists of the Following One-Seventh Grant Amounts from
Qualifying New Machinery and Equipment Purchased During the Calendar Years Indicated:
Carryforward Amounts from 1/1/2005
Total Requested Grant
to 6/30/2005 Qualifying Purchases
(to Schedule A)
Schedule C – Pass-Through Entities That Purchased Equipment for Which the Taxpayer Is Claiming the Grant
Name of Pass-Through Entity
FEIN
NAICS Code
Taxpayer’s
Ownership %
Schedule D – Location of Manufacturing Facilities by County
(attach additional sheet if necessary)
Ohio County
Street Address of Taxpayer’s Manufacturing
Principal Products Manufactured at the Facility
Facilities or Pass-Through Entity’s Manufacturing
Facilities in the Ohio County
I declare under penalties of perjury that this grant request form has been examined by me and to the best of my knowledge and belief
is true, correct and complete.
Taxpayer’s signature (if taxpayer is an individual)
Date
Signature of offi cer or managing agent
Date
(if taxpayer is other than an individual)