Form Dr 0078 - Application For Extended Enterprise Zone Tax Credits In Terminated Enterprise Zone Area Page 2

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*130078==29999*
New business facility (NBF) employee credit
$
Year
(YYYY)
Credit
Claimed
Agricultural processing NBF employee credit
$
Year
(YYYY)
Credit
Claimed
NBF employee health insurance credit
$
Year
(YYYY)
Credit
Claimed
V. Joint Certification by Taxpayer and Enterprise Zone Administrator
We hereby certify to the Colorado Department of Revenue that the information provided herein is true and correct to the
best of our knowledge.
Taxpayer Signature
Title
Date
(MM/DD/YY)
Enterprise Zone Administrator Signature
Date
(MM/DD/YY)

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