Form 332 - Arizona Credits For Healthy Forest Enterprises - 2014 Page 5
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7Name (as shown on Form 332)
TIN
Page
of
Form 332-1
Qualified Employees of Healthy Forest Enterprise
2014
Complete a Form 332-1 for each qualified employee of the Healthy Forest Enterprise. See instructions for Form 332-1 (included with
Instructions for Form 332) about providing the requested information in an alternative format
.
1
Employee name:
2
Employee’s taxpayer identification number (TIN) ...........................................
3
Did employee reside in Arizona on date of hire? ............................................
Yes
No
4
Brief description of employee’s job duties:
M M D D Y Y Y Y
5
Current date of employment ...........................................................................
6
If employee was previously employed by the business, list the previous date
M M D D Y Y Y Y
of employment. (See instructions.) ................................................................
7a Is the employee in a permanent full time position? .........................................
Yes
No
7b If the answer to line 7a is “Yes”, list the number of hours the employee actually
worked during the taxable year ........................................................................
7c If the answer to line 7b is less than 1550 hours annually, explain:
$
00
8
Employee’s annual compensation for the taxable year ..............................................................................
$
00
9a Total cost of health insurance provided by employer for employee. (See instructions.) ............................
$
00
9b Total cost of health insurance for employee paid by employer. (See instructions.) ...................................
10
Is this employee in a new qualified employment position? .............................
Yes
No
11
Check only one box:
First year employee
Second year employee
Third year employee
ADOR 10683 (14)
Print 332-1
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