Form Mitc-A - Application For West Virginia Manufacturing Investment Tax Credit For Investments Placed In Service On Or After January 1, 2003

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Application for West Virginia Manufacturing Investment Tax Credit
MITC-A
for Investments Placed in Service On or After January 1, 2003
REV 12-11
Identification Number
Name
Tax Year
Business Name
_______________, ____________ to _______________, ____________
Street Address
City, Town, or Post Office
State
Zip Code
Application is hereby made to the Tax Commissioner of West Virginia for allowance of Manufacturing Investment Tax Credit with respect to qualified
manufacturing investment property placed in service or use during Applicant’s tax year ending:
/
/
MM
DD
YYYY
**Manufacturers must complete items 1 through 5 and the certification. Businesses whose primary NAICS code is 211112 must complete
items 1 through 6 and the certification.**
1. Investment Purpose (Check only 1)
Industrial Expansion
Industrial Revitalization
Both Industrial Expansion and Revitalization
2. Business Activity in West Virginia:
a) North American Industry Classification System Code (NAICS): ___________________________________
b) Narrative Description of Business Activity in West Virginia:
Total Investment
Qualified Investment
3a. Investment
Year________________________
Amount $___________________
$___________________________
3b. Location(s) of Investment in West Virginia _________________________________________________________
3c. General Description of Qualified Investment (Narrative):
Schedule MITC-A Page 1 of 2
REV. 12-11

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