DR 0077 (09/10/13)
*130077==19999*
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0005
Certification of Qualified Enterprise
Zone Research & Development Expenditures
This information regarding expenditures on research and development is a confidential tax document.
Beginning January 1, 2012, before a taxpayer engages
Complete this DR 0077 only if you cannot do so
in any activity for which they intend to claim an Enterprise
electronically. Electronic submissions reduce errors
Zone income tax credit, they must submit a pre-certification
that may delay the processing of your applications
form to the Enterprise Zone Administrator. This
and income tax returns.
pre-certification can be initiated at
, the Colorado Office of
Economic Development's Enterprise Zone Web page.
Pre-Certification
Businesses: Complete each field, read the pre-certification
Zone Administrators: Read the pre-certification
statement, then sign and date where indicated. Forward
statement, then sign and date where indicated. Return the
the signed form to the appropriate Enterprise Zone
signed form to the business.
Administrator. For a list of names and contact information,
please visit .
Information is for tax year ending
(YYYY)
Enterprise Zone
Type of Business (retail, mfg, farm, etc.)
Business Name
NAICS Code (from )
Address - Actual location of facility
Business Telephone Number
(
)
City
State
Zip
I, the business owner or authorized company official, certify that I am aware of the Enterprise Zone program, that Enterprise
Zone tax credits are a contributing factor to the startup, expansion or relocation of my business in the Enterprise Zone,
and I acknowledge that this pre-certification is for activities that shall commence after the date that the Enterprise Zone
administrator signs this form to pre-certify through the end of my business’s current income tax year.
Business Owner or Authorized Company Official Signature
Date
(MM/DD/YY)
I, the duly authorized administrator of the above mentioned Enterprise Zone, hereby certify to the State of Colorado,
Department of Revenue, that the above named facility is entirely within the designated Enterprise Zone; and hereby
pre-certify this business in my Enterprise Zone.
Enterprise Zone Administrator
Date
(MM/DD/YY)
See back for Certification