Annual Report For Bo Tax Credit On New Employees
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Annual Report
Washington State
Department of Revenue
Taxpayer Account Administration
for B&O Tax Credit on New Employees
Special Credits & Assessments Team
PO Box 47476
Olympia WA 98504-7476
Certificate Number:________________
Annual reports are required in two consecutive years for each approved credit, see next page for additional information on
due dates. Positions hired after the end of four consecutive calendar quarters are not considered for this credit, but may be
included on a new application if workforce expansion of 15% or greater is anticipated during the following four quarters.
Credit for a position may not be received under both this program and the software B&O Job Credit Program or the
International Services Job Credit Program. This application reflects legislative changes of House Bill 1566 effective
January 1, 2008.
Business Identification
Name of Business
Name of Contact Person (all correspondence will be directed to this person)
Address
Telephone Number
City
State
Zip Code
Department of Revenue Tax Reporting Account Number
-
-
-
Department of Employment Security Identification Number
Facility Location
Please complete one application for each separate facility that is expanding positions.
Check one:
County
Rural County
Community Empowerment Zone
Street Address
City
State
Zip Code
*Note: If the facility is located in a CEZ, all new employees must also reside within the CEZ to qualify for this credit.
Please provide the names and addresses of the employees within the CEZ on a separate page.
Does the applicant operate in other Washington locations?
Yes
No
If reporting on credits for more than one facility, please complete an Annual Report for each facility.
More information on the B&O Tax Credit on New Employees may be found at dor.wa.gov. Please refer to RCW 82.62 or
WAC 458-20-240. For assistance, please call (360) 902-7175.
Signature ___________________________________________ Date ___________________________
Print Name _________________________________________
Return Completed Form to:
Taxpayer Account Administration
Special Credits & Assessments
PO Box 47476
Olympia, WA 98504-7476
To inquire about the availability of this form in an alternate format for the visually impaired, please call 1-800-647-7706. Teletype (TTY)
users may use the Washington Relay Service by calling 711.
REV 41 0077a (02/17/15)
Page 1
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