Form 349 - Arizona Credit For Qualified Facilities - 2014
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1
2Arizona Form
2014
Credit for Qualified Facilities
349
Include this completed form and the Certification of Qualification from the Arizona Commerce Authority with your return.
For the calendar year 2014 or fiscal year beginning
2 0 1 4 and ending
.
M M D D
M M D D
2 0
Y Y
Name as shown on Form 140, 140PY, 140NR, 140X, 99T, 120, 120A, 120S, 120X, or 165
Social Security or
Employer Identification Number
Listing of Post-Approved Qualified Facilities and Apportioned Credit Amount
Part 1
List qualified facilities for which you are entitled to claim a credit during this taxable year. If you have more than two facilities, include
additional schedules. See instructions.
(a)
(b)
Arizona Commerce Authority Post-Approval Information
Apportioned Credit Amount
(a)1
(a)2
(a)3
Allocation Year
Post-Approval Date
Post-Approval Number
M M D D Y Y Y Y
00
1
Y Y Y Y
M M D D Y Y Y Y
Y Y Y Y
00
2
00
3
Aggregate total from all additional schedules ............................................ 3
00
4
TOTAL: Add lines 1 through 3 .................................................................. 4
Part 2
Credit Recapture
M M D D Y Y Y Y
5
Date on which the Certification of the business as a qualified facility was terminated or revoked ....
5
6
Total recapture of apportioned credit for qualified facility. Full amount of credits previously claimed
or passed through to S corporation shareholders or partners of a partnership. Enter the amounts
from Part 1, column (b) on Form 349 for the tax years prior to the date on line 5. If more than one
00
Certification has been terminated or revoked, enter the aggregate amount .....................................
6
Part 3
S Corporation Credit Election and Shareholder’s Share of Credit and Credit Recapture
M M D D Y Y Y Y
7
The S corporation has made an irrevocable election for the taxable year ending
to
(check only one box):
Claim the credit for qualifi ed facilities as shown on Part 1, line 4 (for the taxable year mentioned above);
OR
Pass the credit for qualified facilities as shown on Part 1, line 4 (for the taxable year mentioned above), through to its
shareholders.
Signature
Title
Date
If passing the credit through to the shareholders, complete lines 8 through 10 separately for each shareholder. If passing credit recapture
through to the shareholders, complete line 11 separately for each shareholder. Furnish each shareholder with a copy of the Certification
from Commerce and pages 1 and 2 of Form 349.
8
Name of shareholder:
9
Shareholder’s TIN:
00
10
Shareholder’s share of the apportioned credit for qualified facilities from Part 1, line 4 .................... 10
00
11
Shareholder’s share of the credit recapture from Part 2, line 6 ......................................................... 11
Continued on page 2
ADOR 11192 (14)
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