Form 40 0036ae - Business And Occupation (B&o) Tax Credit Application For Employee Training
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1Washington State
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Department of Revenue
PO Box 47476
Olympia WA 98504-7476
Business and Occupation (B&O) Tax
ATTN: SC&A
Employment Security Department
Credit Application for Employee Training
PO Box 9046, Olympia, WA 98507-9046
ATTN: ECDD/Labor Exchange Coordinator
This application is for a B&O Tax Credit for training provided under RCW 82.04.4333 for approved projects under RCW
82.60 for manufacturing, research and development and computer service businesses located in designated distressed areas. If
you have questions, please contact Employment Security at (360) 486-5942.
1. Business Name:
2. Phone Number:
3. Address:
Street
City
State
Zip
4. Unified Business Identifier (UBI):
5. Tax Deferral Number:
6. Nature of your business activity:
7. Name of training provider:
(Attach certification of accredited institution if training provider is the employer)
8. Is the training provided to the employees free of charge?
Yes
No
$
9. Proposed cost of training:
10. Number of employees to attend training:
11. Briefly describe the proposed job training.
(If additional space is needed, please attach additional pages.)
12. Briefly describe how training will enhance the employee’s performance.
(If additional space is needed, please attach additional
pages.)
The employer certifies that the statements and answers provided here are true and correct:
Name (please print)
Title
Signature
Date
If you have been approved, you will receive a B&O Tax Employee Training Credit Affidavit. Attach the affidavit to your
Combined Excise Tax Return when you claim the credit.
For Employment Security Department Official Use Only
For Department of Revenue Taxpayer Account Administration
Total Approved Training Cost:
Official Use Only
Appr oved
$
$
Total Training Cost Approved by ESD:
X
.20
Disapproved – Reason:
Required certification not attached
Application incomplete
$
Total Available B&O Tax Credit Issued:
Other:
Training provider not certified
Approved By:
Approved By:
Title:
Date:
/
/
Title:
Date:
/
/
For tax assistance or to request this document in an alternate format, visit or call 1-800-647-7706. Teletype (TTY) users may call
(360) 705-6718.
REV 40 0036ae (8/2/11)
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