State Form 21928 - Schedule It-40qec - Enterprise Zone Qualified Employee Deduction Certificate - 2015

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Schedule IT-40QEC
Indiana Department of Revenue
Enclosure
2015
State Form 21928
Enterprise Zone
Sequence No. 18
(R11 / 9-15)
Qualified Employee Deduction
Certificate
--- Keep this form with your records ---
Name of employee
Social Security Number Name of Enterprise Zone ___________
Date of residence in Enterprise Zone:
From ____________ To ____________
Employee’s street address
Amount of compensation for tax year
during the period of residence in the
Enterprise Zone: $_________________
City of residence
Caution: Limitation of Deduction
Enter ½ of the above amount or $7,500,
whichever is less: $________________
Employer
Address
Federal Identification Number
I certify that the above-named employee was paid the amount indicated as compensation for services rendered, and that he/she is a
qualified employee as defined in I.C. 6-3-2-8.
Signature of employer
Title
Telephone number
Date
Instructions for completing Schedule IT-40QEC
Schedule IT-40QEC is to be completed by the enterprise zone employer and distributed to its qualified employee(s). The qualified em-
ployee should claim this deduction on IT-40 Schedule 2, IT-40PNR Schedule C, or Form IT-40X (amended tax return). The employee
must enclose the IT-40QEC with the state individual income tax return to support any claimed deduction of earned enterprise zone
income.
Indiana Code I.C. 6-3-2-8 defines a “qualified employee” as an individual who:
1.
Has a principal place of residency in the enterprise zone where employed;
2.
Performs services for the employer 90 percent of which are directly related to the conduct of the employer’s trade or business
located in an enterprise zone;
3.
Performs services for the employer at least 50 percent of the time during the taxable year within an Indiana state enterprise
zone; and
4.
Is employed by a business that remains eligible to receive benefits and incentives as provided by enterprise zone legislation.
Portions of certain Indiana cities are designated as state enterprise zones. A qualified employee living and working in a designated
enterprise zone may be entitled to deduct from state adjusted gross income one-half of the enterprise zone income earned for
services or $7,500, whichever is less. Enterprise zone income means wages, salaries, commissions and any other forms of remuner-
ation paid to qualified employees for services by an enterprise zone employer, minus any IRA deductions directly related to that earned
income.
For a listing of all current enterprise zones and contact information for each zone please visit
Privacy Notice: The records in this series are CONFIDENTIAL according to the provisions of I.C. 6-8.1-7-1 and I.C. 5-28-15-8
*24100000000*
24100000000

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