Biotechnology Products And Medical Devices Application For Sales And Use Tax Deferral 82.75 Rcw Page 3
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1
2
3
4Employment Information
Estimated Investment Project Costs
Please include only those costs that will be paid for by the
21. Average Number of Full Time Equivalents (FTEs) for
applicant.
Previous Calendar Year.
(1820 annualized hours worked = 1 FTE):
16. Structure:
Entire Business:
Date building permit will be issued
At This Facility:
Construction of new structure(s)
22. Estimated or actual number of new
Leasehold improvements paid for by
FTEs as a result of this project:
applicant
23. Estimated or actual wages of FTE’s related to this project:
Expansion or renovation to expand
floor space or production capacity
Construction of cogeneration facility
Total Structure Costs
Use of Facility
17. Machinery & Equipment:
All businesses must maintain a qualified activity at the site of
the investment project for the year in which the investment
Date equipment is to be installed
project is certified as operationally complete, plus seven
Purchase Price
additional years.
Yes
No
Lease Contract Price
24. Do you plan to operate this investment
Fair market value of previously owned
project in a qualified manner for 8 years
machinery and equipment that is new
from the time the project is complete?
to the State of Washington
25. If the answer to question 24 is “No”,
Total Machinery & Equipment Costs
how long do you plan to operate this
investment project with qualified use?
18. Total Costs
If the manufacturing or research and development activity is
19. Estimated Completion Date:
not maintained, all or a portion of the deferred taxes
outstanding for this investment will be immediately due. The
department will assess interest at the rate provided for
Apportionment of Structure
delinquent excise taxes, but not penalties, retroactively to the
date of the deferral.
If the facility is used partly for research and development and
partly for other purposes, the applicable tax deferral shall be
determined by apportioning the costs of construction.
Audit Records Location
20. Percentage of facility devoted to:
If your application is approved, a deferral certificate will be
0.00%
Accounting/Payroll
%
issued using the estimates from your application. Upon
0.00%
Administration
%
completion of the project, an auditor will verify that you are
performing qualified activities at this facility. They will also
Cafeteria
0.00%
%
verify that the approved percentage of your structure and
0.00%
Common Areas
%
100% of the machinery and equipment are eligible for the
0.00%
Conference & Training Rooms
%
deferral. The auditor may adjust the allowable deferral based
on his or her findings.
0.00%
Customer Service
%
0.00%
Manufacturing
%
To minimize inconvenience and the time it takes to complete
0.00%
an audit, please have the following records for the audit
Pilot Scale Manufacturing
%
period available for your meeting with the auditor:
0.00%
Reception Area
%
0.00%
Purchase invoices (i.e., accounts payable, receipts)
Research & Development
%
0.00%
Sales & Marketing
%
Supporting documentation for the construction,
0.00%
such as construction contracts
Warehouse
%
0.00%
Other (please describe)
%
Original Sales and Use Tax Deferral Certificate
Total
100 %
(continued next page)
REV 81 1017e (8/19/11)
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