Form Lm - Nebraska Advantage Rural Development Act Application For Livestock Modernization Projects Page 2

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APPLICATION (cont’d.)
FOR NDR USE ONLY
Complete
Incomplete
B
Explanation of how applicant intends to satisfy the chosen levels:
4B
D
Expected Benefits (see
Calculation
Tips)
4D
ATTACH a copy of completed Worksheet LM, provided in the Calculation Tips. The total
estimated credits cannot exceed $30,000.
Investment
a
Expected investment increase
b
Expected investment credits
May not exceed $30,000
If item 5, 6, 7, or 8 is not available, indicate why the document is not available. If a reorganization occurred
since the previous tax year, provide copies of the documents for the previous entity(ies) and a written
explanation.
5
5 Attach copy of most recent financial statements (check each attached):
Audited financial report, including opinion letter
Unaudited financial statements
6 Enclose copy of most recent federal income tax filing. Include copy of first 4 pages, schedules supporting the
6
first 4 pages, Affiliations Schedule (Form 851), and a copy of each Shareholder’s Share of Income Credits,
Deductions, etc. (Schedule K-1). If the applicant is a sole proprietorship, provide a copy of the Profit
or Loss from Business (Schedule C) or the Profit or Loss from Farming (Schedule F).
7 Enclose copy of most recent Nebraska income tax return.
7
Are all entities listed in item 2 on page 1 included in one unitary NE tax return?
YES
NO
If No, explain why:
Explain any difference between taxable income per the federal return and the amount reported to
Nebraska:
8 Enclose copy of most recent Nebraska Reconciliation of Income Tax Withheld, Form W-3N.
8
9 Nebraska sales and use tax number for each entity listed in item 2 on page 1 (if not licensed, attach a copy
9
of the Nebraska Tax Application, Form 20, and proof of date submitted):
Entity Name
Sales/Use Tax ID No.
1
2
3
4
(If you need more room, attach a schedule)
10 E-MAIL. If you allow the department to contact you by e-mail, you accept any risk of loss of confidentiality associated with this method of
communication.
AUTHORIZED SIGNATURE. This application must be signed by the owner/taxpayer, partner, member, corporate officer, or other individual
authorized to sign by a power of attorney on file with the department.
sign
here
Authorized Signature
Telephone Number
Please print your name
Title (See Instructions)
E-mail Address
Street or Other Mailing Address
City, State, Zip Code

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