Form Rev-765 Ct - Schedule Jc - Annual Report Page 6

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PAGE 2
REV-765 CT (01-05)
Calculation of Claimed Job Tax Credit/Job Creation Tax Credit
Business Name
Calendar Year of Employment 20
SCHEDULE JC
Account ID #
III *
IV
Section
Section
Summary of Employment History in PA
Allowance for each Full-time Qualified
A
B
C
Job Created Job by Year of Employment
Monthly Average
Monthly Average
Monthly Average
January 1, 2001, to December 31, 2001
$500
of All Full-time
of Qualified Full-time
of Non-Qualified Full-time
Years
Jobs in PA
Jobs in All KOZ/KOEZ
Jobs in PA
January 1, 2002, to December 31, 2002
$750
2000
January 1, 2003, to December 31, 2003
$1,000
2001
January 1, 2004, to December 31, 2004
$1,250
2002
January 1, 2005, to December 31, 2005
$1,250
2003
2004
January 1, 2006, to December 31, 2006
$1,250
2005
January 1, 2007, to December 31, 2007
$1,250
2006
January 1, 2008, to December 31, 2008
$1,250
2007
January 1, 2009, to December 31, 2009
$1,250
2008
2009
January 1, 2010, to December 31, 2010
$1,250
2010
January 1, 2011, to December 31, 2011
$1,250
2011
January 1, 2012, to December 31, 2012
$1,250
2012
January 1, 2013, to December 31, 2013
$1,250
2013
* First Time Filer: Provide Information regarding full-time jobs in PA starting with the year immediately preceding the calendar year in which full-time
jobs existed within a Subzone or Expansion Subzone or calendar year 2000, whichever is later. GENERAL RULE: For the base
I
year, the entry for Column A is the end product of the calculation for Section
on Page 1.
** Adjusted for full-time jobs created within a Zone but the jobs didn’t qualify until a subsequent calendar year.
Section
V
Calculation of Claimed Job Tax Credit/Job Creation Tax Credit
Department
Use Only
Lines
Monthly Average of All Full-time Jobs in PA for this Calendar Year of Employment
1
1
II
(Block A of Section
on Page 1)
Highest Number of the Monthly Average of Non-Qualified Full-time Jobs in PA from
Less
2
Less: 2
III
Column C of Section
above
Maximum Number of Full-time Qualified Jobs Eligible for Job Tax Credit/Job Creation Tax Credit
= 3
=
3
(Please note, if result is zero or below, STOP - Company is not eligible to apply this year.)
OR
OR
Monthly Average of Qualified Full-time Jobs in All KOZ/KOEZ for Calendar Year
4
4
II
Employment (Block B of Section
on Page 1)
= 5
=
5
Qualified Full-time Jobs - Record Lower of Lines 3 or 4
TIMES: 6
6
IV
Record Applicable Allowance for year of employment from Section
above
Multiply
= 7
=
Line 5 times Line 6 = Total Claimed Job Tax Credit/Job Creation Tax Credit for year of Employment
7
(Note: The tax credit shall not exceed 50% of the tax liability of a qualified business or person under Article
III
,
IV
,
VI
or
of the Tax Reform Code of 1971 for the tax year. The Job Creation Tax Credit may not be carried forward or
backward to any other year.)
I certify that the Conditions of Employment stated above were fulfilled and that I am authorized to execute this
CERTIFICATION
application on behalf of the company and that it is true, correct, and complete.
Signature of Corporate Officer
Print Name of Corporate Officer
Date
TITLE:
TELEPHONE NUMBER:
COMMONWEALTH USE ONLY
THE TAX CREDIT CLAIMED ON THIS SCHEDULE IS:
CREDIT AWARDED
APPROVED
APPROVED AS
DISAPPROVED
MODIFIED
FOR THE SECRETARY OF REVENUE
$
REVENUE OFFICER
The credit awarded is subject to departmental audit.
DATE

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