Schedule K-59 - High Performance Incentive Program (Hpip) Credits Page 2

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12. Enter your ownership percentage. See instructions ................................................................................... 12. _______________ %
13. Amount of credit available this tax year or prior year’s carry forward (multiply line 11u by 12) ................... 13. _________________
14. Amount of tax liability for current year after all previous claimed credits ..................................................... 14. _________________
15. Amount of credit used ................................................................................................................................. 15. _________________
16. Amount of carry forward for next year’s Schedule K-59 ............................................................................... 16. _________________
PART D - NEW INVESTMENT INFORMATION
17. Number of actual jobs created as a direct result of this qualified business facility investment. ................ 17.
_________________
18. Additional payroll generated as a direct result of actual jobs created on line 17 ....................................... 18.
_________________
19. Actual number of jobs retained that would have been eliminated if not for this qualified business
facility investment ........................................................................................................................................ 19.
_________________
20. Payroll for actual jobs retained on line 19 ................................................................................................... 20.
_________________
21. Additional revenue or loss generated as a direct result of this qualified business facility investment. ...... 21.
_________________
22. Additional sales generated as a direct result of this qualified business facility investment ....................... 22.
_________________
23. Total employment in the state of Kansas .................................................................................................... 23.
_________________
24. Total payroll in the state of Kansas ............................................................................................................. 24.
_________________
PART E – CARRY FORWARD SCHEDULE
25. First Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
26. Second Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
27. Third Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
28. Fourth Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
29. Fifth Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
30. Sixth Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
31. Seventh Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
32. Eighth Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
33. Ninth Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
34. Tenth Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
Lines 35 through 40 are to be used for HPIP carry forward on UNEXPIRED credits where the investments were placed into service
in taxable years commencing after December 31, 2000.
35. Eleventh Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
36. Twelfth Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
37. Thirteenth Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
38. Fourteenth Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
39. Fifteenth Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________
f. Credit Fwd Available ______________
40. Sixteenth Year
a. Tax Year _________________
b. Certification No. ________________
c. Certification Date _________________
Carry Forward
d. Carry Fwd Amt ____________
e. Credit Used ___________________

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