Division Of Treasury Application Form Personal

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DIVISION OF TREASURY
255 ROCKVILLE PIKE, SUITE L-15
ROCKVILLE, MARYLAND 20850
240-777-8965
APPLICATION FORM
PERSONAL PROPERTY BUSINESS TAX CREDIT –
HOME COMPUTER TELECOMMUTING INCENTIVE
Business Name: ________________________________________________________________________
Business Mailing Address: _________________________________________________________________
Personal Property Tax Account Number(s): ____________________________________________________
COMPUTER INFORMATION
Type (PC or Laptop)
Name / Series / Serial #
Purchase Date / Amount
1
_________________
_______________________________
____________________________
2
_________________
_______________________________
____________________________
3
_________________
_______________________________
____________________________
4
_________________
_______________________________
____________________________
5
_________________
_______________________________
____________________________
6
_________________
_______________________________
____________________________
7
_________________
_______________________________
____________________________
8
_________________
_______________________________
____________________________
EMPLOYEE INFORMATION
Employee Name
Employee Address
% Employee Telecommutes
1
_________________
___________________________________
more than 30% YES / NO__
2
_________________
___________________________________
more than 30% YES / NO__
3
_________________
___________________________________
more than 30% YES / NO__
4
_________________
___________________________________
more than 30% YES / NO__
5
_________________
___________________________________
more than 30% YES / NO__
6
_________________
___________________________________
more than 30% YES / NO__
7
_________________
___________________________________
more than 30% YES / NO__
8
_________________
___________________________________
more than 30% YES / NO__
REQUIRED ITEM
A. To be approved for this credit, the employer must submit with this application, or subsequently provide,
proof of purchase of each new home computer or laptop, it must include the date of purchase and the cost
of each computer or laptop.
I hereby certify under oath and affirmation, subject to the penalties provided by law, that the information and
responses in this application are true and correct to the best of my knowledge, information, and belief.
SIGNATURE OF BUSINESS OWNER
APPLICATION DATE

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