Form Jobz1 - Certification Of Job Opportunity Building Zone (Jobz), Compliance With Business Subsidy Agreement (Bsa) Page 2
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1
2JOBZ Certifi cation (JOBZ1) Instructions
Who must complete this form?
Eligibility requirements
Email address
If you are a qualifi ed business participat-
As a qualifi ed business, you are required to
If the department has questions regarding
ing in the Job Opportunity Building Zone
meet and maintain your eligibility require-
your Form JOBZ Certifi cation form and you
(JOBZ) program, you must provide a fully
ments as determined by your business
want to receive correspondence electroni-
completed certifi cation of eligibility each
subsidy agreement (BSA).
cally, be sure to provide your email address.
year with the Department of Revenue. Th is
Line 5
Please note that:
form is used to determine continued eligi-
Enter on line 5 the number of employees
bility to receive JOBZ benefi ts and must be
1.
Businesses that properly indicate “NO”
currently in the JOBZ zone. Do not use the
received no later than October 15.
on lines 1 or 3 are no longer eligible for
number of employees you had when you
JOBZ benefi ts, and are subject to the
Failure to submit the JOBZ Certifi cation
entered the JOBZ program.
JOBZ repayment provisions of Min-
will result in removal from the JOBZ pro-
nesota Statute § 469.319.
Signature
gram. You will also be subject to repayment
of prior JOBZ tax benefi ts received.
An authorized representative of the quali-
2.
Other businesses that properly indicate
fi ed business must sign and date the form.
“YES” on line 1, but “NO” on line 7
Th is form is in addition to any other report-
may not be subject to repayment of
ing requirements with the Department of
When to fi le
JOBZ benefi ts, and under certain cir-
Revenue, the zone administrator, or the
By October 15, 2015, mail JOBZ Certifi ca-
cumstances may be eligible for limited
Department of Employment and Economic
tion form, to:
future JOBZ benefi ts.
Development (DEED).
Minnesota Revenue
County and parcel ID number
In addition, businesses that have been
Mail Station 9901
terminated from the JOBZ program but
Enter the county in which the qualifi ed
St. Paul, MN 55146-9901
maintain a substantial level of the activities
business is located. Enter the main prop-
or fax to: 651-556-3102
described in the business subsidy agreement
erty’s parcel ID, or property ID, number
should continue to fi le this form for the
assigned to it by the county. You can fi nd
Do not submit this form with your tax
duration of the zone term. Completing this
the parcel or property ID number on the
return.
form will assist the Department of Revenue
property tax statement.
in verifying the business’s continued opera-
Use of information
Minnesota business ID number
tions within the zone.
All information provided on JOBZ Certifi -
Enter the registered Minnesota business ID
cation form is public.
Qualifi ed business
number. Th is is a seven digit number and is
You are a qualifi ed business if your place of
Th e information will be used to administer
used to fi le your Minnesota tax fi lings.
business is located within a JOBZ zone and
the JOBZ program, and will be shared with
JOBZ ID number
you have signed a Business Subsidy Agree-
the Department of Employment and Eco-
Enter your Minnesota JOBZ ID Number
nomic Development to the extent necessary
ment with the zone administrator.
which can be located on your JOBZ M500
to administer the JOBZ laws.
A qualifi ed business also includes an
form.
agricultural processing facility located in a
Questions or need forms?
designated agricultural processing facility
Business Subsidy Agreement
You can fi nd forms and the most current
zone.
(BSA) date
information on our website at
In the area provided, enter the date the
qualifi ed business’s Business Subsidy Agree-
If you have questions, call 651-556-6836
ment (BSA) was signed.
during business hours.
We’ll provide information in other formats
upon request.
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