Form Dr 0078 - Application For Extended Enterprise Zone Tax Credits In Terminated Enterprise Zone Area Page 2

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DR 0078 (11/09/08)
colorado department of revenue
DenveR CO 80261-0005
application for extended enterprise zone tax credits
in terminated enterprise zone area
Joint certification by taxpayer and enterprise zone administrator
i. enterprise zone
Effective date of termination
Date termination of this
area officially announced:
of this zone area:
SSN or Colorado Tax ID#
ii. taxpayer name
Mailing Address
FEIN
Contact Person
Location of Enterprise Zone Facility
Phone
Date Established/Acquired/Planned to be Established by Taxpayer
iii. describe business planning documentation in place prior to the announcement of the zone termination
(do not attach; retain with your tax records):
Utility service applications
Real estate acquisition plans
Plant or eqpt.
Permit applications (zoning,
purchasing specs
building, environmental, etc.)
Financing plans
Other—please describe:
iv. planned activity eligible for enterprise zone tax credits through ten years following termination of zone.
tax credit
amount of planned
cumulative total
For each credit, complete line 1 when requesting certification.
investment, Jobs, etc.
anticipated tax credits
Complete the boxes on lines 2 and 3 each year a credit is claimed.
$
$
investment tax credit
Year
Credit Claimed
$
$
Job training tax credit
Year
Credit Claimed
$
new business facility (nbf) employee credit
Year
Credit Claimed
$
agricultural processing nbf employee credit
Year
Credit Claimed
$
Year
Credit Claimed
V. Joint Certification by Taxpayer and Enterprise Zone Administrator
We hereby certify to the colorado department of revenue that the information provided herein is true and correct to the best of our knowledge.
Taxpayer Signature
Title
Date
Enterprise Zone Administrator Signature
Date

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