Form Dtf-621 - Claim For Qetc Employment Credit - 2015

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Department of Taxation and Finance

DTF-621

Claim for QETC Employment Credit

Tax Law – Articles 9-A and 22

All filers must enter tax period:

beginning

ending

Taxpayer identification number

Name as shown on return

File this form with corporate franchise tax return Form CT-3, CT-3-A, or CT-3-S, or with

income tax return Form IT-201, IT-203, IT-204, or IT-205.

Mark with an X the tax year for which you are claiming the qualified emerging technology company (QETC) employment credit

on this return: 1

A Partner in a partnership, S corporation shareholder, or a beneficiary of an estate or trust:

enter your share of the QETC employment credit

................

(see instructions, Form DTF-621-I)

Taxpayer identification number

Business name of the partnership, S corporation, estate, or trust

(All the questions in Schedule A pertain to the tax year for which you are claiming the credit.)

Schedule A – Eligibility requirements

Part 1 – Location and sales

(mark X in the appropriate boxes)

1 Is the company located in New York State? .................................................................................................... Yes

2 Are the total annual product sales of the company $10,000,000 or less? ..................................................... Yes

If you answered Yes to questions 1 and 2, continue with Part 2. If you answered No to either question 1 or 2, you do not qualify for

a QETC employment credit for the current tax year.

Part 2 – QETC business activities

Research and development (R&D) activities

(see instructions)

3 Does the company have R&D activities in New York State? .......................................................................... Yes

If No, skip lines 4 through 7 and continue with question 8. If Yes, continue with line 4.

4 Enter the amount of R&D funds ................................................................................................

5 Enter the amount of net sales

(if you have any amount of R&D funds but zero net sales, you are a

.........................................................................

QETC; skip line 6 and mark the Yes box on line 7)

6 R&D funds percentage

....................................

(divide line 4 by line 5; enter the result as a percentage)

7 Does the percentage on line 6 equal or exceed 2.7%? ................................................................................. Yes

If Yes, you are a QETC; continue with Part 3. If No, continue with question 8.

Primary products and services

8 Does the company develop or create products or services that are classified as emerging technologies? ...... Yes

If Yes, enter in the box below a description of the company’s emerging technology products or services, and continue with line 9.

If you answered No to lines 3 and 8 or lines 7 and 8, you cannot claim this credit.

9 Enter the gross receipts or sales from the company’s emerging technology products or

services described on line 8 that were included on your federal return .................................

10 Enter from your federal return the gross receipts or sales from all the company’s products or services

If line 10 is zero, skip lines 11 and 12 and continue with line 13.

If line 10 is greater than zero, continue with line 11.

11 Divide line 9 by line 10

..............................................................

(enter the result as a percentage)

12 Is the percentage on line 11 greater than 50%? ............................................................................................. Yes

If Yes, continue with Part 3. If No, you cannot claim this credit.

B If you are claiming this credit as a corporate partner, mark an X in the box ...................................................................................

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