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 4
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43. 3.
Employment:
Employment:
Payroll
Payroll
Jobs
Jobs
a)
Total WV Payroll and Number of Jobs Prior to Investment:
b)
Total WV Payroll and Number of Jobs This Tax Year:
c)
Projected WV Payroll and Number of Jobs After 3 Years:
%
d)
Jobs Percentage and Projected Number of New Jobs:
4.
4.
Does the taxpayer elect to begin the (10) year credit period with the next succeeding taxable year?
Does the taxpayer elect to begin the (10) year credit period with the next succeeding taxable year?
Yes
Yes
No
No
5.
5.
(Multiple Party Projects Only)
(Multiple Party Projects Only)
Additional Participant
Federal Identification
Tax Year
Credit Allocation
Name(s)
Number
Ending
Percentage/Amount
1.
2.
3.
4.
5.
6.
Under penalties of perjury, I declare that I have examined this application (including accompanying schedules
and statements) and to the best of my knowledge and belief it is true, and complete.
(Signature of Taxpayer)
(Name of Taxpayer-Type or Print)
(Title)
(Date)
(Person to Contact Concerning this Return)
(Telephone Number)
(Signature of Preparer other than Taxpayer)
(Address)
(Date)
Please return the completed application to the West Virginia State Tax Department, P.O. Box 902, Charleston, WV 25323-
0902. If you have any questions or need further information regarding this application, telephone (304) 558-3333 or toll
free to 1-800-WVA-TAXS (1-800-982-8297).
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