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Form Wv/bcs - Notice To Tax Commissioner Of Claim For West Virginia Business Investment And Jobs Expansion Tax Credit Page 2

WV/BCS - Transition

ORIG. 9/02

NOTICE TO TAX COMMISSIONER OF CLAIM FOR

West Virginia Business Investment And Jobs Expansion Credit

Under Transition Rules (Due December 31, 2002)

Name

Identification Number

Street Address

City, Town or Post Office

State

Zip Code

1) List the names and federal identification numbers of all other project participants (multiple party projects only).

2) Which of the Following Transition Rules Apply? (Check Appropriate Box)

Qualified Investment Property Placed Into Service Or Use Prior To January 1, 2004 But After

December 31, 2002 To Complete An Investment Period Beginning On _________.

Investment Placed Into Service Between January 1, 2003 And January 1, 2004 Pursuant To A

Written Binding Contract Executed Prior To January 1, 2003.

Investment Placed Into Service By One Or More Qualified Taxpayers For A Multiple Year Project

Beginning before January 1, 2003, Including Projects Certified Pursuant To A Written Binding Contract

Executed Prior To January 1, 2003.

Projected Investment $ _________________

Projected New Jobs ______

Under penalties of perjury, I declare that I have examined this document (include accompanying schedules and

statements), and to the best of my knowledge and belief it is true, and complete.

__________________________________________________________________________________________________

(Signature of Taxpayer)

(Name of Taxpayer-Type or Print)

(Title)

__________________________________________________________________________________________________

(Person to Contact Concerning This Return)

(Telephone Number)

__________________________________________________________________________________________________

(Signature of Preparer other than Taxpayer)

(Address)

(Date)

Form Wv/bcs - Notice To Tax Commissioner Of Claim For West Virginia Business Investment And Jobs Expansion Tax Credit Page 2