Form Eotc-A - Application For West Virginia Economic Opportunity Tax Credit For Investments Placed In Service On Of After January 1, 2003 Page 5
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2
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4
5If the box for “Other” in 1b (i.e., Type of Credit) was
activity in West Virginia.
3f 3f
checked, enter the value of the minimum compensation
for the new jobs created.
Describe the business expansion activity in West
5b 5b
Virginia that is associated with your new investment
B
(e.g., construction of a reconstituted wood product manufacturing
enefitS
plant).
Health insurance – Enter the percentage of your
4a 4a
employees covered, the average annual cost per employee
c
p
redit
eriod
(i.e., benefit costs divided by number of covered employees), and
the number of new jobs with health insurance.
Taxpayers have an option of beginning their utilization
6 6
of tax credits with the year investment is first placed
Retirement – Enter the percentage of your employees
into service or with the succeeding taxable year. Check yes or no
4b 4b
covered, the average annual cost per employee (i.e. benefit
depending upon which option you choose. Once an election is
costs divided by number of covered employees), and the number of
made either way it becomes irrevocable.
new jobs with company-provided retirement benefits.
Within a reasonable time after receipt of the Application the
State Tax Commissioner or his designee will acknowledge, in
Other Benefits – List other company benefits provided
4c 4c
writing, receipt, of this application and authorize the Applicant to
(e.g., child care) and enter the percentage of your
begin claiming Economic Opportunity Tax Credit benefits. Such
employees covered, the average annual cost per employee (i.e.,
acknowledgement and authorization will not bar or otherwise
benefit costs divided by number of covered employees), and the
prevent the Tax Commissioner from auditing or examining
number of new jobs with the benefit.
Applicant’s books and records for compliance with the Economic
Opportunity Tax Credit law and regulations.
B
A
W
v
uSineSS
ctivity in
eSt
irginiA
This application must be signed by an officer of the company to
Enter your North American Industry Classification
5a 5a
❦
be valid.
Code (NAICS) that most closely describes your business
Application for West Virginia Economic Opportunity Tax Credit
Application
for West Virginia Economic Opportunity Tax Credit
EOTC-A •
EOTC-A •
• Page 3
• Page 3
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