Delaware Form 2080de - New Economy Jobs Program Application
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STATE OF DELAWARE
Print Form
Form 2080DE
New Economy Jobs Program Application
An applicant for the New Economy Jobs Program must submit an application for certification as a qualified
employer to the Secretary of Finance with a copy to the Director of Economic Development before any credits
can be approved.
New Certification
Amended Certification (Attach Copy of Previous
Certification).
PART A - - NAME AND ADDRESS
1. Name of Taxpayer:
.
2. Federal Employer Identification Number: 1 -
.
.
.
.
.
.
.
-
- -
or Social Security Number: 2 -
.
.
.
.
.
.
.
3. Address:
.
Street
City
State
Zip Code
4. Delaware Address (if different from above):
.
Street
City
State
Zip Code
5. Contact Person Name:
Telephone Number: (
)
.
Fax Number: (
)
.
Email Address:
.
PART B - - INFORMATION FOR QUALIFCATION
1. Year Employer is claiming as its “Certified Year”:
.
2. Year Employer is claiming as its “Base Year”:
.
3. Number of “Qualified Employees” in “Certified Year”:
.
4. Number of “Qualified Employees” in “Base Year”:
.
.
Name of Employer Officer (Print)
Title
Date
.
Signature of Employer Officer
_____________
Certification Approved
Certification Denied.
.
Thomas J. Cook, Secretary of Finance
Date
(Revised 04/01/10)
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