Form M500a - Jobz Motor Vehicle Purchase Report

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JOBZ Motor Vehicle Purchase Report
M500A
Use this form as a supplement to Form M500, JOBZ Tax Benefit Report, to report additional purchases of motor vehicles
that are principally garaged in the JOBZ zone and primarily used to carry out zone operations.
Name of qualified business
Taxpayer name (if different from JOBZ business) JOBZ ID number
Business address in the zone
FEIN
Minnesota tax ID
City
State
Zip code
County
Primary parcel ID
MN
Taxpayer:
C-Corporation
S-Corporation
Partnership
Individual
Fiduciary
Other
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
VIN
$
I declare that this report is correct and complete to the best of my knowledge and belief.
Signature of authorized representative of qualified business
Date
Daytime phone
Include this form with Form M500 and mail to:
Minnesota Revenue
Mail Station 9901
St. Paul, MN 55146-9901
Phone: 651-556-6836
(For email/fax instructions, call the number listed above.)
New 7/09

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