Form B "Application for Certification - Qualified Maryland Biotechnology Company - Maryland Biotechnology Investment Incentive Tax Credit" - Maryland

What Is Form B?

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 B "Application for Certification - Qualified Maryland Biotechnology Company - Maryland Biotechnology Investment Incentive Tax Credit" - Maryland

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MARYLAND BIOTECHNOLOGY INVESTMENT INCENTIVE TAX CREDIT
APPLICATION FOR CERTIFICATION
FORM B – QUALIFIED MARYLAND BIOTECHNOLOGY COMPANY
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. Signature required.
CHECK ONE:
QMBC APPLICATION
PENDING QMBC APPLICATION
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. Full Legal Name of Organization
2. Email Address
3. Federal Tax Identification
4. Unemployment Insurance Number
5. Number of Full-time Maryland Employees
6. Legal Form of Entity
C Corporation
S Corporation
LLC
LLP
Limited Partnership
General Partnership
7. Primary Contact Person
Last Name
Suffix
(Jr., Sr., III)
First Name
Middle Name
Title/ Occupation
Main Telephone
(Include Area Code)
Business Telephone
(Include Area Code)
Email Address
8. Secondary Contact Person
Last Name
Suffix
(Jr., Sr., III)
First Name
Middle Name
Title/ Occupation
Main Telephone
(Include Area Code)
Business Telephone
(Include Area Code)
Email Address
9. Business Address
City
State
Postal Code
County
*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 4
MARYLAND BIOTECHNOLOGY INVESTMENT INCENTIVE TAX CREDIT
APPLICATION FOR CERTIFICATION
FORM B – QUALIFIED MARYLAND BIOTECHNOLOGY COMPANY
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. Signature required.
CHECK ONE:
QMBC APPLICATION
PENDING QMBC APPLICATION
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. Full Legal Name of Organization
2. Email Address
3. Federal Tax Identification
4. Unemployment Insurance Number
5. Number of Full-time Maryland Employees
6. Legal Form of Entity
C Corporation
S Corporation
LLC
LLP
Limited Partnership
General Partnership
7. Primary Contact Person
Last Name
Suffix
(Jr., Sr., III)
First Name
Middle Name
Title/ Occupation
Main Telephone
(Include Area Code)
Business Telephone
(Include Area Code)
Email Address
8. Secondary Contact Person
Last Name
Suffix
(Jr., Sr., III)
First Name
Middle Name
Title/ Occupation
Main Telephone
(Include Area Code)
Business Telephone
(Include Area Code)
Email Address
9. Business Address
City
State
Postal Code
County
*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 4
MARYLAND BIOTECHNOLOGY INVESTMENT INCENTIVE TAX CREDIT
APPLICATION FOR CERTIFICATION
FORM B – QUALIFIED MARYLAND BIOTECHNOLOGY COMPANY
APPLICATION FOR CERTIFICATION-TAX YEAR 20__
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. Signature required.
10. Investment Information
Proposed date upon which the investment will be made
Total Investment Amount
$
11. Attachments - Please attach the following information to your application. Multiple attachments 11 – Form B do
not have to be completed for investors in a prospective QMBC if current Form B - attachments 11 are on file
with Commerce and are 30 days old or less. However, Form B answers to numbers 1 through 10 and numbers
12 through 13 must be completed.
11.1
A current certified copy of organization’s articles of incorporation, articles of organization,
partnership agreements, or other organizing documents issued within the last 30 days.
11.2
A current certificate of good standing, having been issued within the last 30 days, from the Maryland
State Department of Assessments and Taxation (SDAT). For foreign entities, in addition to the
Maryland SDAT certification, file a certificate of status issued within the last 30 days from the state/
jurisdiction of organization.
11.3
The names, business addresses and titles of all officers, directors, managing members, general
partners, or other persons with management authority over the business of the applicant.
The name, address and the percentage of ownership of each person or entity who or which holds
11.4
equity interests in the qualified Maryland biotechnology company of any class or classes that
constitute five percent (5%) or more of the total equity capital of the company.
Submit two copies of any investment agreement or similar contract between the qualified investor
11.5
and qualified Maryland biotechnology firm entered into or to be entered into in connection with the
making of the investment.
Submit two copies of a formal business plan that describes in sufficient detail the business and
11.6
operations of the company to establish that the company is organized and operated as a
biotechnology company as defined in the Act, including general descriptions of the biological
materials and related technology used or intended to be used or developed, the methods and goals
of ongoing or anticipated research, and existing or anticipated commercial biological or
biomolecular products. Also include: complete financial statements (Balance Sheet and Income
Statement) and the list of full-time employees with duties and work hours per week.
As part of or supplemental to the business plan include:
11.6(a) Copies of licenses, grants and awards with a schedule reflecting the amounts already drawn
down and future availability.
11.6(b) Verification of any intellectual property - list of patents and patent numbers already held; for
applications pending submit confirmation of filing - can be appropriate pages from the patent
application.
11.6(c) Expenses in the Income Statement should contain a separate break out of R & D versus
Selling, General and Administrative expenses.
11.6(d) Balance Sheet should reflect Equity-common and preferred stock and paid in capital.
*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 4
MARYLAND BIOTECHNOLOGY INVESTMENT INCENTIVE TAX CREDIT
APPLICATION FOR CERTIFICATION
FORM B – QUALIFIED MARYLAND BIOTECHNOLOGY COMPANY
APPLICATION FOR CERTIFICATION-TAX YEAR 20__
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. Signature required.
Address and detailed description of the company headquarters and addresses of additional sites
11.7
and descriptions of the business, financial, research, production operations and number of full-time
employees at each site.
11.8
Submit one copy of any private placement memorandum, prospectus or like disclosure and
information documents, and of any filings with securities regulatory agencies, prepared or made by the
qualified Maryland biotechnology company as issuer in connection with the investment.
A detailed description of the uses and purposes to which the investment will be applied by the
11.9
qualified Maryland biotechnology company. Please be specific: giving the amount of anticipated
investment and a breakdown of the costs and purposes for which the investment proceeds are to be
used.
12. Additional Information
Has or does the Applicant, or any partner, director, officer, member, or principal stockholder:
12.1
Been convicted of a criminal offense other than a traffic violation?
Yes
No
12.2
Been a debtor in bankruptcy or insolvency proceedings?
Yes
No
12.3
Been a party to any pending litigation in the past two years?
Yes
No
Does the Applicant, or any partner, director, officer, member, or principal stockholder:
12.4
Owe any outstanding judgments?
Yes
No
12.5
Owe any delinquent taxes?
Yes
No
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)
____________________________________
______________________________________
Print Name
Title
*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 4
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).
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