Form Lm - Nebraska Advantage Rural Development Act Application For Livestock Modernization Projects

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Nebraska Advantage Rural Development Act Application
LM
for Livestock Modernization Projects
RESET
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Livestock Production applicants must use the L1L2 Application.
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
Legal Name of Applicant
Name
Street Address (Do not use P.O. Box)
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
FOR NDR USE ONLY
Complete
Incomplete
1 A
Attach check for $500 application fee.
1A
1 B
Employee Verification
1B
a
Will the applicant have any employees at the Livestock Modernization project?
YES
NO
i
If the answer is YES, complete all employee verification questions.
ii
If the answer is NO, continue with question 2.
b
Is the taxpayer registered for E-Verify, the federal electronic verification program
used to confirm whether employees are authorized to work in the United States?
YES
NO
c
If YES, do you agree to use E-Verify for employees hired in Nebraska after the
date of application?
YES
NO
d
If the answer to question 1B(b) or 1B(c) is NO, do not complete the rest of the
application because you are not eligible to apply for this Nebraska tax incentive program.
e
Print out the “Company Information” from the E-Verify program and include it as an attachment.
2 Exact name of applicant and any other entities, including disregarded entities, to be part of the project
Entity Name
Entity Type
FEIN
NE Income Tax ID No.
A
2A
1
2
3
4
(If you need more room, attach a schedule)
B
If each entity in 2A is not included on the Affiliations Schedule, Form 851, attached as part of item 8,
provide an explanation of how the entities are related to each other.
2B
C
What is the applicant’s tax year end?
If it does not agree with the copy of the tax return
provided in item 8 below, provide an explanation.
2C
3 Describe the applicant’s business:
A
Narrative:
3A
B
Type of Livestock:
3B
C
Federal Principal Business Activity Code:
3C
Federal Business Activity Title:
4 Project definition
A
Project location(s)
4A
Address (Street, City)
County
Enterprise Zone (Y or N)
1
2
3
4
5
8-617-2006 Rev. 3-2012
Supersedes 8-617-2006 Rev. 9-2009

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