Form Wv/bcs-A - Application For West Virginia Business Investment And Jobs Expansion Tax Credit For Investments Placed In Service On Or After January 1, 1990 Page 3
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4Form WV/BCS-A
(Rev. 12/99)
Application For Business Investment and Jobs Expansion Credit For Investments Placed In Service On Or
After January 1, 1990
After January 1, 1990
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 Business Investment and Jobs Expansion
Tax Credit ("Super Tax Credit") with respect to qualified investment property placed in service or use during Applicant's tax year ending
, and the new jobs created by the Applicant that are directly attributable to the qualified investment property
and that are filled by persons who are domiciled in this State.
If this Application is being made on behalf of a multiparty project, Applicant represents to the Tax Commissioner that the Applicant
is authorized by each of the other participants in the project to make this Application.
1a.
1a. Application Status (Check Only One):
Application Status (Check Only One):
One Year Investment, One Taxpayer
a)
Multiple Year Investment, One Taxpayer
b)
Must receive
Certification From
Single Year Investment, Multiple Party Taxpayers
c)
Attach List of Parties
Tax Commissioner
Multiple Year Investment, Multiple Party Taxpayers
d)
Attach List of Parties
1b.
1b. Type of Credit:
Type of Credit:
Regular Super Credit
Headquarters Relocation
Small Business
2a.
2a. Investment:
Investment:
Total Investment
Total Investment
Qualified Investment
Qualified Investment
(1)
Year
Amount $
$
(2)
Year
Amount $
$
Multiple Year
Projects Only
(3)
Year
Amount $
$
2b.
2b. Location(s) of investment in West Virginia
Location(s) of investment in West Virginia
2c.
2c. General Description of Qualified Investment:
General Description of Qualified Investment:
Narrative:
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