Form B "Application for Certification - Qualified Maryland Cybersecurity Company - Maryland Cybersecurity 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.

Form Details:

  • The latest edition provided by the Maryland Department of Commerce;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form B by clicking the link below or browse more documents and templates provided by the Maryland Department of Commerce.

ADVERTISEMENT
ADVERTISEMENT

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

108 times
Rate (4.5 / 5) 8 votes
MARYLAND CYBERSECURITY INVESTMENT INCENTIVE TAX CREDIT APPLICATION FOR CERTIFICATION
FORM B – QUALIFIED MARYLAND CYBERSECURITY COMPANY
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 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. 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
Other
LLC
LLP
General Partnership
Limited Partnership
C Corp
S Corp
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, § 10-733(i).
Page 1 of 4
MARYLAND CYBERSECURITY INVESTMENT INCENTIVE TAX CREDIT APPLICATION FOR CERTIFICATION
FORM B – QUALIFIED MARYLAND CYBERSECURITY COMPANY
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 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. 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
Other
LLC
LLP
General Partnership
Limited Partnership
C Corp
S Corp
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, § 10-733(i).
Page 1 of 4
MARYLAND CYBERSECURITY INVESTMENT INCENTIVE TAX CREDIT APPLICATION FOR CERTIFICATION
FORM B – QUALIFIED MARYLAND CYBERSECURITY COMPANY
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 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 of Form B do
not have to be completed for prospective investors in a QMCC 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.
A certified copy of organization’s articles of incorporation, articles of organization, partnership agreements, or
11.1
other organizing documents certified within the last 30 days.
A current certificate of good standing, having been issued within the last 30 days, from the Maryland State
11.2
Department of Assessments and Taxation. For foreign entities, also file a certificate of status issued within the
last 30 days from the state/jurisdiction of organization.
The names, business addresses and titles of all officers, directors, managing members, general partners, or
11.3
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 equity
11.4
interests in the qualified Maryland cybersecurity 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 or
11.5
qualified Maryland cybersecurity firm entered into or to be entered into in connection with the making of the
investment.
Submit two copies of a formal business plan (not presentations for investors or offering prospectus) that
11.6
describes in sufficient detail the business and operations of the company to establish that the company is
organized and operated as a cybersecurity company as defined in the Act, including: descriptions of the
proprietary 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 cybersecurity products. Also include:
complete financial statements and the list of full-time employees with duties and work hours per week.
11.6(a) Copies of licenses, grants and awards with a schedule reflecting the amounts already drawn down and
future availability.
11.6(b) Vertification 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.
Address and detailed description of the company headquarters and addresses of additional sites and
descriptions of the business, financial, research, production operations and number of full-time employees at
each site.
Submit one copy of any private placement memorandum, prospectus or like disclosure and information
11.8
documents, and of any filings with securities regulatory agencies, prepared or made by the qualified Maryland
cybersecurity 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 qualified
11.9
Maryland cybersecurity company. Please be specific, giving the amount of anticipated investment and a
breakdown of the cost and purposes for which the investment proceeds are to be used.
* 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 4
MARYLAND CYBERSECURITY INVESTMENT INCENTIVE TAX CREDIT APPLICATION FOR CERTIFICATION
FORM B – QUALIFIED MARYLAND CYBERSECURITY COMPANY
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 required.
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)
_
_
Title
Print Name
*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 3 of 4
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
th
401 East Pratt Street – 17
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
th
Street, 17
Floor, Baltimore, MD 21202. om
Form
o s r
so r
r
s o
or r
o . 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
r 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 full
om
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).
Page 4 of 4
Page of 4