Form R-1039 - Enterprise Zone Refundable Investment Income Tax Credit Claim For Refund
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R-1039 (11/08)
Enterprise Zone Refundable Investment
Income Tax Credit Claim for Refund
Mail:
Date of Claim (mm/dd/yyyy)
Office Audit Division
ICFT Unit
P. O. Box 66362
Baton Rouge, LA 70896-6362
(225) 219-2270
PLEASE PRINT OR TYPE.
LA Revenue Account Number
Enterprise Zone Project Contract No.
Legal Name of Business
Trade Name of Business
Mailing Address
Project Location Address
City
State
ZIP
City
State
ZIP
Project Completion Date (date indicated on Project Completion Report)
Date Project Completion Report Signed by Board of Commerce and Industry
Total Qualified Expenditures
Amounts classified as capital expenditures for federal income tax purposes that are re-
lated to the contract project and are placed in service from the beginning of construction
1
1
until the date of project completion (Other related capitalized intangible expenditures such
as architectural and engineering costs prior to construction are includible.)
PLUS: Amounts that would have been capitalized but for exclusions from capitalization as
2
2
provided in IRC §263(a)(1)(A) – (L)
LESS: The capitalized cost of land, land leases, interest, purchase of an existing building
(except any properly capitalized costs of rehabilitation) and manufacturing machinery and
3
3
equipment (to the extent the capitalized manufacturing machinery and equipment costs
are excluded from sales and use tax under R.S. 47:301(3))
PLUS: The capitalized basis of qualified expenditures properly reduced by claiming a
4
4
federal credit
5
5
Total qualified expenditures
X
.015
6
Applicable percentage
6
7
7
REFUNDABLE INVESTMENT TAX CREDIT – Multiply Line 5 by Line 6.
This claim may be filed only after the project completion report is signed by the Board of Commerce and Industry. Attach
schedules that detail the qualified expenditure amounts reported on Lines 1, 2, 3, and 4 and copies of the fully executed Project
Completion Report and the Enterprise Zone or Quality Jobs contract.
Declaration
I declare that to the best of my knowledge of all available information, this refund claim is true and complete and complies with all
statutes, rules and regulations, and any other policy pronouncements related to the enterprise zone program refundable investment
income tax credit.
Signature of Officer, Owner or Other (for Other, attach Power of Attorney)
Date (mm/dd/yyyy)
X
Print Name
Title
Contact Telephone Number
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