Refundable Life Science Credit Life Science Company - Massachusetts Department Of Revenue Forms - 2013

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2013

Massachusetts

Refundable Life Science Credit

Department of

Life Science Company

Revenue

The Life Sciences Tax Incentive Program under M.G.L. Ch. 23I, sec. 5(a) and 5(d)) authorizes the Massachusetts Life Sciences Center (MLSC) to approve

applications from “life sciences companies” for specified tax benefits. Taxpayers may claim such benefits only as, and to the extent, such benefits were previ-

ously authorized by the MLSC. Taxpayers with unused Life Sciences Investment Tax Credits or FDA User Fees Credits under Ch. 62, sec. 6(m) and 6(n) or

Ch. 63, sec. 31M or 38U may apply for a refund of the current year credits remaining after reducing their tax liability, in lieu of any carryover to future years,

at 90% of the value of such unused credits.

Corporations with unused credits under Ch. 63, sec. 38M from the current or prior years may similarly request a refund of their unused credits at 90% of

their value to the extent authorized by the MLSC.

If taking a Life Science Credit against excise and not seeking a refund based upon the Life Science Credit, do not file this schedule. See TIR 08-23 for

further information.

For calendar year 2013 or taxable year beginning

and ending

Taxpayer name

Federal Identification number

Mailing address

City/Town

State

Zip

Designated life science company representative

Telephone

E-mail address

Name of life science company (if different from the taxpayer named above)

1 Amount of Ch. 63, sec. 38M credit authorized for refund under the Life Sciences Tax Incentive Program. Enter “0” on

lines 1 through 3 if not seeking a refund of Massachusetts Research Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Massachusetts Ch. 63, sec. 38M credit unused at year end (from Schedule RC, Part 3, line 20) . . . . . . . . . . . . . . . . . . . . . . . 2

3 Massachusetts Ch. 63, sec. 38M credit available for refund. Enter the smaller of lines 1 or 2. The refund is first issued

from credits that will expire, then oldest available if line 1 is smaller than line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Life Sciences Investment Tax Credit available for refund. Enter “0” if not seeking a refund of Life Sciences ITC or if not

authorized by the MLSC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Economic Opportunity Area Credit available for refund, if applicable (not more than the smaller of Schedule EOAC, line 9

or 17c). Enter “0” if not seeking a refund of EOAC or if not authorized by the MLSC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Life Sciences FDA User Fees Credit available for refund. Enter “0” if not seeking a refund of Life Sciences FDA UFC or

if not authorized by the MLSC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Total credits available for refund. Combine lines 3 through 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Tax after credits (from Form 355, line 8; Form 355S, line 11; Schedule U-ST, line 41; or other appropriate form) . . . . . . . . . . . 8

9 Subtract line 8 from line 7. Not less than “0” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Multiply line 9 by .9 (90%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Refundable credit under the Life Sciences Tax Incentive Program. Enter the smaller of line 7 or the total of the amounts

on lines 8 and 10, whichever is smaller. Enter here and on Form 355 or Form 355S; Schedule RF, line 3; Form 355U,

Schedule U-RF, line 4; or other appropriate form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

I declare under the pains and penalties of perjury that to the best of my knowledge, the information contained herein is accurate and complete.

Signature

Date