Form A.1 "Application for Certification - Qualified Investor, Individual - Maryland Biotechnology Investment Incentive Tax Credit" - Maryland

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This is a legal form that was released by the Maryland Department of Commerce - a government authority operating within Maryland. As of today, no separate filing guidelines for the form are provided by the issuing department.

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Download Form A.1 "Application for Certification - Qualified Investor, Individual - Maryland Biotechnology Investment Incentive Tax Credit" - Maryland

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MARYLAND BIOTECHNOLOGY INVESTMENT INCENTIVE TAX CREDIT
APPLICATION FOR CERTIFICATION
FORM A.1 – QUALIFIED INVESTOR, INDIVIDUAL
APPLICATION FOR CERTIFICATION -TAX YEAR 201__ or
for Fiscal Year Taxpayers, Tax Year _______
IMPORTANT – Because the Maryland Biotechnology Investment Tax Credit is limited and capped, applications
are accepted on a first come, first served basis.
Applications will not be accepted prior to 9:00 am June 1, 2018. Signature(s) required.
For Internal Use Only
WARNING: False statements made knowingly and willfully in this tax credit application,
including affidavits or other supporting documents submitted therewith, are punishable by law.
All statements and documents are subject to verification.
1. Name of Applicant
Last Name
Suffix (Jr., Sr., III)
First Name
Middle Name
2. Date of Birth (mm-dd-yyyy)
3. Social Security Number
4. Email Address
If property is to be jointly owned, complete the following duplicate items 1b through 4b:
1b. Name of Spouse (if property is to be jointly owned)
Last Name
Suffix (Jr., Sr., III)
First Name
Middle Name
3b. Social Security Number
2b. Date of Birth (mm-dd-yyyy)
4b. Email Address
5. Mailing Address
City
State
Postal Code
6. Title/Occupation
7. Employer Name
8. Business Address
City
State
Postal Code
9. Business Telephone (Include Area Code)
10. Investment Amount
$
*Applicants should be aware that all information submitted in or accompanying an application may be subject to the provisions of the
Maryland Public Information Act (Md. Code, State Government Article, Title 10, Subtitle 6, Part III) and to the provisions of Md. Code, Tax
General Article, § 10-725(h).
Page 1 of 3
MARYLAND BIOTECHNOLOGY INVESTMENT INCENTIVE TAX CREDIT
APPLICATION FOR CERTIFICATION
FORM A.1 – QUALIFIED INVESTOR, INDIVIDUAL
APPLICATION FOR CERTIFICATION -TAX YEAR 201__ or
for Fiscal Year Taxpayers, Tax Year _______
IMPORTANT – Because the Maryland Biotechnology Investment Tax Credit is limited and capped, applications
are accepted on a first come, first served basis.
Applications will not be accepted prior to 9:00 am June 1, 2018. Signature(s) required.
For Internal Use Only
WARNING: False statements made knowingly and willfully in this tax credit application,
including affidavits or other supporting documents submitted therewith, are punishable by law.
All statements and documents are subject to verification.
1. Name of Applicant
Last Name
Suffix (Jr., Sr., III)
First Name
Middle Name
2. Date of Birth (mm-dd-yyyy)
3. Social Security Number
4. Email Address
If property is to be jointly owned, complete the following duplicate items 1b through 4b:
1b. Name of Spouse (if property is to be jointly owned)
Last Name
Suffix (Jr., Sr., III)
First Name
Middle Name
3b. Social Security Number
2b. Date of Birth (mm-dd-yyyy)
4b. Email Address
5. Mailing Address
City
State
Postal Code
6. Title/Occupation
7. Employer Name
8. Business Address
City
State
Postal Code
9. Business Telephone (Include Area Code)
10. Investment Amount
$
*Applicants should be aware that all information submitted in or accompanying an application may be subject to the provisions of the
Maryland Public Information Act (Md. Code, State Government Article, Title 10, Subtitle 6, Part III) and to the provisions of Md. Code, Tax
General Article, § 10-725(h).
Page 1 of 3
MARYLAND BIOTECHNOLOGY INVESTMENT INCENTIVE TAX CREDIT
APPLICATION FOR CERTIFICATION
FORM A.1 – QUALIFIED INVESTOR, INDIVIDUAL
APPLICATION FOR CERTIFICATION -TAX YEAR 201__ or
for Fiscal Year Taxpayers, Tax Year _______
IMPORTANT – Because the Maryland Biotechnology Investment Tax Credit is limited and capped, applications
are accepted on a first come, first served basis.
Applications will not be accepted prior to 9:00 am June 1, 2018. Signature(s) required.
11. Additional Information
Has the Applicant:
11.1
Been convicted of a criminal offense other than a traffic violation?
Yes
No
11.2
Been a debtor in bankruptcy or insolvency proceedings?
Yes
No
11.3
Been a party to any litigation in the past two years?
Yes
No
Does the Applicant:
11.4
Owe any outstanding judgments?
Yes
No
11.5
Owe any delinquent taxes?
Yes
No
12. Provide the percentage of ownership in the proposed Qualified Maryland Biotechnology Company.
Name of QMBC/Company: _____________________________________________________
Before the proposed acquisition of ownership
_________%
After the proposed acquisition of ownership
_________%
13. Oath and Signature
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and
belief, it is true, correct, and accurately lists the amount of investments during the tax year.
X __________________________________
_____________________________________
Applicant's Signature
Date (mm-dd-yyyy)
X _________________________________
_____________________________________
Spouse's Signature (if property is to be jointly owned)
Date (mm-dd-yyyy)
*Applicants should be aware that all information submitted in or accompanying an application may be subject to the provisions of the
Maryland Public Information Act (Md. Code, State Government Article, Title 10, Subtitle 6, Part III) and to the provisions of Md. Code, Tax
General Article, § 10-725(h).
Page 2 of 3
INSTRUCTIONS
GENERAL INFORMATION
1. Complete appropriate Qualified Investor Form (Form A.1, A.2, or A.3).
2. Complete Qualified Maryland Biotechnology Company ("QMBC") Form (Form B).
3. Send complete application including appropriate investor form, QMBC Form B, and all requested
documents to the Maryland Department of Commerce.
4. Applications should be delivered to the following address:
ATTN: Biotechnology Investment Incentive Tax Credit Program
Maryland Department of Commerce
Tax Incentives Group
World Trade Center
th
401 East Pratt Street – 17
Floor
Baltimore, Maryland 21202
Beginning on May 15, 2018, Commerce will accept Form B applications for companies to be pre-
qualified as a QMBC. Early applications will be accepted through May 22, 2018. Precertification will
occur as soon as the applications have been reviewed. Notifications will be sent out no later than June 8,
2018.
CERTIFICATION PROCESS
Commerce will be using a two-step application procedure for the fiscal year beginning July 2, 2018.
Step 1: Beginning June 1, 2018, completed applications with all attachments will be accepted at the Commerce offices
located at the Maryland Department of Commerce, Tax Incentives Group, World Trade Center,
401 East Pratt Street, 17th Floor, Baltimore, MD 21202. A User Name and Reference Number will
be issued within 72 hours, except applications received after June 22, 2018 will have a User
Name and Reference Number issued after July 2, 2018.
Step 2: The second step of the application process will require that the User Name and Reference Number be used to
electronically complete the submission beginning at 9:00 am EDT on July 2, 2018 through the website
located at www.mdbiotaxcredit.org. Submission order of the applications will be determined by “first come
first served” based ONLY on the electronic submission of the User Name and Reference Number. No
physical application can be filed for purposes of the ordering of first come first served.
Multiple submissions by an applicant using the same user name and reference number will be considered filed at the
date and time of the LAST submission. This rule is to maintain that the application procedure is as fair and equitable
as possible. Any decision made by Commerce during the application process is considered final.
Applications are reviewed and approved based on the order received. At least 30 calendar days but no more than 60
calendar days prior to making a qualifying investment, the qualified investor submits a completed application to
Commerce. Within 30 calendar days of receiving the application, Commerce will issue an initial tax credit certificate
certifying the amount of any approved tax credits to a Qualified Investor or offer rejection. A qualified investor has 30
days after the date Commerce issues the initial tax credit certificate to make an investment in the QMBC. Within 10
days of making the investment, the qualified investor shall provide written notice with supporting documentation to
Commerce. If the qualified investor fails to provide notice of investment to Commerce within 40 days after the
issuance of the initial tax credit certificate Commerce shall rescind the certificate. Based on the actual investment
Commerce shall issue a final tax credit certificate.
*Applicants should be aware that all information submitted in or accompanying an application may be subject to the provisions of the
Maryland Public Information Act (Md. Code, State Government Article, Title 10, Subtitle 6, Part III) and to the provisions of Md. Code,
Tax General Article, § 10-725(h).
Page 3 of 3
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