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

What Is Form A.1?

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 Cybersecurity Investment Incentive Tax Credit" - Maryland

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MARYLAND CYBERSECURITY 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 Cybersecurity Investment Tax Credit is limited and capped,
applications are accepted on a first come, first served basis. 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
2b. Date of Birth (mm-dd-yyyy)
3b. Social Security Number
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, § 10-733(i).
Page 1 of 3
MARYLAND CYBERSECURITY 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 Cybersecurity Investment Tax Credit is limited and capped,
applications are accepted on a first come, first served basis. 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
2b. Date of Birth (mm-dd-yyyy)
3b. Social Security Number
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, § 10-733(i).
Page 1 of 3
MARYLAND CYBERSECURITY 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 Cybersecurity Investment Tax Credit is limited and capped,
applications are accepted on a first come, first served basis. 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 Cybersecurity Company.
Name of QMCC/Company: ______________________________________________________
Before the proposed acquisition of ownership
%
After the proposed acquisition of ownership
%
Oath and Signature
13.
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, § 10-733(i).
Page 2 of 3
Instructions
GENERAL INFORMATION
In order to apply for a Cybersecurity Investment Incentive Tax Credit,
1. Investors should complete the appropriate Qualified Investor Form (Form A.1, A.2, or A.3).
2. Cybersecurity companies should complete Form B to qualify as a Qualified Maryland Cybersecurity Company (“QMCC”).
3. Send all completed forms and requested documents to the Maryland Department of Commerce (“Commerce”) at:
Cybersecurity Investment Incentive Tax Credit
Maryland Department of Commerce
ATTN: Tax Incentives Group
401 East Pratt Street – 17
th
Floor
Baltimore, MD 21202
QMCC PRE-QUALIFICATION
Beginning on August 15, 2018, Commerce will accept Form B applications from cybersecurity companies to be pre-qualified as
QMCCs. Pre-qualification applications will be accepted through August 22, 2018. Commerce will review pre-qualification
requests as soon as completed Form B applications have been received and will send pre-qualification notifications out no
later than September 7, 2018.
INVESTOR APPLICATION PROCESS
The investor application procedure is a two-step process. Please note that an investor must apply for a Cybersecurity
Investment Incentive Tax Credit before they make an investment in a QMCC.
Step 1: Beginning September 4, 2018, completed Investor application Forms A.1, A.2 or A.3, with all attachments, will be
accepted at Commerce’s offices: Tax Incentives Group, Cybersecurity Investment Incentive Tax Credit, 401 East Pratt
Floor, Baltimore, MD 21202. Completed Form B applications are also required if it was not filed for pre-
Street, 17
th
qualification. For completed investor applications received before September 24, 2018, Commerce will issue an investor a
User Name and Reference Number within 72 hours after receipt of the completed investor application. For completed
investor applications received after September 24, 2018, Commerce will issue an investor a User Name and Reference
Number after October 2, 2018.
Step 2: The second step of the application process requires the investor, using the investor’s User Name and Reference
Number, to finalize their application electronically. Electronic submissions will begin at 9:00 a.m. EDT on October 2, 2018,
through the website (http://cybertaxcredit.choosemaryland.org). Awards of tax credits are determined on a “first come, first
served” basis, based solely on Commerce’s receipt of an investor’s electronic submission of their User Name and Reference
Number. No physical submissions will be accepted for this second step.
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.
Any decision made by Commerce during the application process is considered final.
Investor applications are reviewed and approved in the order received. After receiving a fully completed application,
Commerce will either issue an initial tax credit certificate certifying the amount of an approved tax credit to a Qualified
Investor or reject the application. A Qualified Investor has 30 days after the date Commerce issues the initial tax credit
certificate to make an investment in the QMCC. Within 10 days after making the investment, the QMCC must provide written
notice of the investment, with supporting documentation, to Commerce. If the QMCC fails to provide a notice of investment
to Commerce within 40 days after the issuance of the initial tax credit certificate Commerce will rescind the initial tax credit
certificate. Based upon the actual investment, Commerce will 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 §
10-733(i).
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