Form It-604 - Claim For Qeze Tax Reduction Credit - 2013

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IT-604

New York State Department of Taxation and Finance

Claim for QEZE Tax Reduction Credit

Tax Law - Section 16

Note: You must file all pages (1 through 8) with your return. All taxpayers must complete the information below and then complete

either Section 1 (pages 1 through 4) or Section 2 (pages 5 through 8). Do not complete both sections.

All filers enter tax period: beginning

ending

File this claim with your Form IT-201, IT-203, IT-204, or IT-205. See Form IT-604-I, Instructions for Form IT-604, for assistance.

Name(s) as shown on your return

Taxpayer identification number

Name of empire zone (EZ)

Name of qualified empire zone enterprise (QEZE) business

Employer identification number (EIN) of QEZE

(see Definitions for all QEZEs in the instructions)

Mark an X in the box if you are a Clean Energy Enterprise (CEE)

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

Mark an X in the box if you are a QEZE first certified between August 1, 2002, and March 31, 2005, that conducts its operations

on real property it owns or leases, that is located in an EZ and that is subject to a brownfield site cleanup agreement executed

prior to January 1, 2006............................................................................................................................................................................

Mark an X in the box if you are claiming this credit as a partner in a partnership, shareholder of a New York S corporation, or

beneficiary of an estate or trust. ..............................................................................................................................................................

Section 1 – For QEZEs first certified prior to April 1, 2005

(see Important information in the instructions)

of first certification by Empire State Development

(submit copies of all certificates of eligibility

Date

(mm-dd-yyyy)

and EZ retention certificates)

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

Schedule A – Employment test for QEZEs first certified prior to April 1, 2005

(see instructions)

Part 1 – EZ employment – Computation of the employment number within all EZs for the current tax year and the five-year base

period. Include employees within all EZs, even if you are not certified in all of those zones