"Application for Preliminary Certification - Maryland Job Creation Tax Credit" - Maryland

Application for Preliminary Certification - Maryland Job Creation Tax Credit is a legal document that was released by the Maryland Department of Commerce - a government authority operating within Maryland.

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Maryland Job Creation Tax Credit
Application for Preliminary Certification
Page 1 of 2
General Information about the Applicant:
1) Business Name:
2) Business Address: ___________________________________________________________________________
___________________________________________________________________________
3) FEIN:
3) UI Number:
4) Type of Entity (Corp, S-Corp, LLC, etc.)
5) (a) Business NAICS Code:
5) (b) Facility NAICS Code (if different):
6) Facility Address: _____________________________________________________________________________
_____________________________________________________________________________
7) County Where the Facility is Located
Project Information
8) Intent Date:
9) Effective Date of Start-Up or Expansion:
10) Located in JCTC PFA (please check all that apply)
State Enterprise Zone
Federal Empowerment Zone
Inside the I-495 or I-695 Beltway
Sustainable Community
Incorporated Municipality
County Designated Growth Area
11) Projected Job and Wage Information
Year
Total
Qualified Positions
per Year
Aggregate Annual
Wage ($)
12) All Projected Jobs Pay at Least 120% of State Minimum Wage: Yes
No
13) Type of activity business is “primarily engaged in” at a business facility (check all that apply)
Manufacturing
Forestry / Fishing
Biotechnology
Mining
Research
Central Financial Services
Transportation
Development
Central Real Estate Services
Communications
Testing
Central Insurance Services
Public Utility
Computer Related Services
Company Headquarters
Warehousing / Distribution
Computer Programming
Central Administrative Offices
Agriculture
Data Processing
Business Services (in a JCTC PFA)
Operations of entertainment, recreation, cultural or tourism related activities in a multiuse facility located within a revitalization area if
the facility generates a minimum of 1,000 new full-time equivalent filled positons in a 240month period.
14) Description of Activities Performed and Products Produced at Facility: _________________________________
___________________________________________________________________________________________
September 2017
Maryland Job Creation Tax Credit
Application for Preliminary Certification
Page 1 of 2
General Information about the Applicant:
1) Business Name:
2) Business Address: ___________________________________________________________________________
___________________________________________________________________________
3) FEIN:
3) UI Number:
4) Type of Entity (Corp, S-Corp, LLC, etc.)
5) (a) Business NAICS Code:
5) (b) Facility NAICS Code (if different):
6) Facility Address: _____________________________________________________________________________
_____________________________________________________________________________
7) County Where the Facility is Located
Project Information
8) Intent Date:
9) Effective Date of Start-Up or Expansion:
10) Located in JCTC PFA (please check all that apply)
State Enterprise Zone
Federal Empowerment Zone
Inside the I-495 or I-695 Beltway
Sustainable Community
Incorporated Municipality
County Designated Growth Area
11) Projected Job and Wage Information
Year
Total
Qualified Positions
per Year
Aggregate Annual
Wage ($)
12) All Projected Jobs Pay at Least 120% of State Minimum Wage: Yes
No
13) Type of activity business is “primarily engaged in” at a business facility (check all that apply)
Manufacturing
Forestry / Fishing
Biotechnology
Mining
Research
Central Financial Services
Transportation
Development
Central Real Estate Services
Communications
Testing
Central Insurance Services
Public Utility
Computer Related Services
Company Headquarters
Warehousing / Distribution
Computer Programming
Central Administrative Offices
Agriculture
Data Processing
Business Services (in a JCTC PFA)
Operations of entertainment, recreation, cultural or tourism related activities in a multiuse facility located within a revitalization area if
the facility generates a minimum of 1,000 new full-time equivalent filled positons in a 240month period.
14) Description of Activities Performed and Products Produced at Facility: _________________________________
___________________________________________________________________________________________
September 2017
Maryland Job Creation Tax Credit
Application for Preliminary Certification
Page 2 of 2
Collection of Personal Information: In accordance with Executive Order 01.01.1983.18, the Department of
Commerce (“Commerce”) advises you as follows: Certain personal information requested by the Department is
necessary in determining your eligibility. Failure to disclose this information may result in the denial of one of
these benefits or services. Availability of this information for public inspection is governed by the provisions of the
Maryland Public Information Act, State Government Article, Sections 10-611 et seq. of the Annotated Code of
Maryland. This information will be disclosed to appropriate staff of the Department and other public officials for
purposes directly connected with administration of the program for which its use is intended. Such information is
routinely shared with State, federal or local government agencies. You have the right to inspect, amend or correct
personal records in accordance with the Maryland Public Information Act.
Publicity: The applicant agrees that the Department of Commerce may issue press releases and otherwise
publicize information about the applicant’s employment levels before and after its qualification for the Job
Creation Tax Credit.
Employment and Wage Data: Periodically the Office of Labor Market Analysis and Information of the Maryland
Department of Labor, Licensing and Regulation (“DLLR”), in cooperation with the U. S. Department of Labor,
Bureau of Labor Statistics (“BLS”), collects employment and wage data from you and other employers who
conduct business in the State of Maryland. This information, collected on the Multiple Worksite Report (BLS 3020)
and the Annual Refiling Survey (BLS 3023), is kept confidential and may only be used by the Department of
Commerce (“Commerce”) with your written consent. Commerce is requesting disclosure of this information in
order to evaluate the effectiveness of Commerce economic development programs and their impact on your
company’s employment level.
Consent: I give consent to DLLR to release the information that our company provides on the BLS 3023 form and
the BLS 3020 form to Commerce, solely for the purpose of evaluating the effectiveness of the Commerce
economic development programs and their impact on our company’s employment level.
Verification: I solemnly affirm under the penalties of perjury and upon personal knowledge that the contents of
the foregoing paper are true.
Date
Signature
(Type or Print)
Name and Title
Business Name
For Further Information Contact
Name:
Title:
Phone:
Email:
Please return this form to:
Mark A. Vulcan
Program Manager, Tax Incentives, Maryland Job Creation Tax Credit Program
Maryland Department of Commerce
401 E. Pratt Street, 17
th
floor
Baltimore, Maryland 21202
September 2017
Maryland Job Creation Tax Credit Instructions
for the Preliminary Application
Below are instructions for filling out the Maryland Job Creation Tax Credit (JCTC) Preliminary Application. The
instructions are guidelines. You may download the JCTC statute and regulations from the Maryland Department of
Commerce’s (Commerce) website at:
http://commerce.maryland.gov/fund/programs-for-businesses/job-creation-tax-
credit
General Information:
1) Provide the full legal name of the entity, as it should appear on the certificate. If Maryland law requires the
business entity to register with the State Department of Assessments and Taxation (SDAT), this name must be
registered as a business entity in good standing. You may check the status of your business entity at:
https://egov.maryland.gov/businessexpress/entitysearch
2) Provide the address of the business entity. This is the address the certificate will be mailed to unless otherwise
noted on the application.
3) Provide the Federal Employee ID Number and unemployment insurance number.
4) Provide the type of business entity, i.e. Corporation, Limited Liability Corporation, Sole Proprietorship.
5) Provide the North American Industrial Classification Code (NAICS) of the business entity and if different, or the
facility that will be creating the new positions. More information on NAICS codes can be found at:
http://www.census.gov/epcd/www/naicstab.htm
6) Provide the address of the facility that will be creating the new positions. The expansion or establishment of a
business must be at a single location in the state. A single business entity may have more than one eligible location,
provided that each is certified and meets the requirements of the statute.
7) Provide the County where the facility is located.
Project Information
8) Provide the date that the business declared its intent to claim the JCTC. A business may only count new qualified
positions created after the intent date.
9) Provide the effective date of the start-up or expansion. This is the date that the business begins creating new
qualified positions.
10) If you are located in one or more JCTC Priority Funding Areas (PFA), please check all areas that apply. If you are
unsure if your address is in a JCTC PFA, contact Emiko Kawagoshi, Tax Incentive Group, Department of Commerce
at 410-767-4041.
11) In the chart, provide the number of “qualified positions” the business projects to create at the facility, the annual
wages of those positions and the year in which they will be created. A qualified position is a full-time position,
paying at least 120 percent of the prevailing State minimum wage. The business entity must create a minimum
number of qualified positions within any 24-month period (after the intent date). The minimums are: a) 60 new
qualified positions; b) 25 new qualified positions in a JCTC PFA; c) 10 jobs in counties with annual average
employment less than 75,000 or median household income less than two-thirds of the statewide median
household income.
12) Verify that all new qualified positions pay at least 120 percent of the prevailing State minimum wage. State
Minimum Wage is $9.25/hr as of July1, 2017, and will increase to $10.10/hr on July 1, 2018. Businesses will have to
pay at least $11.10/hr after July 1, 2017 and $12.12/hr after July 1, 2018.
13) To qualify a business must be primarily engaged in a qualified activity at the facility. This means at least 51 percent
of its business must be in one or more of the activities listed. Check all activities that apply. A business entity that is
primarily engaged in business services must be located in a JCTC PFA to qualify.
14) Provide a written description of the activities performed and products produced at the facility.
Attach a copy of the JCTC/ One Maryland Employment Affidavit to this application.
Attach a copy of “Exhibit A (Collection of Statistical Data about the Applicant)”. Exhibit A is voluntary and does not
affect the eligibility of the applicant.
September 2017
Exhibit A (Collection of Statistical Data About the Applicant)
This form is for gathering statistical data only. The information provided in this form has no
bearing on the Applicant’s eligibility for the tax credit applied for and will not be a part of the
application approval process. Furnishing of this information is voluntary; failure to do so will
have no effect on the approval of the tax credit application.
Respondent does not wish to furnish this information: Yes
No
If the Applicant is a business organization:
If the Applicant is a business that is owned and controlled primarily by individuals who
are identified in any of the following categories, please check all the categories that apply:
Female
Of Hispanic or Latino origin
Asian
American Indian or Alaska Native
Black or African American
Native Hawaiian or other Pacific Islander
White
Veteran
Is the Applicant a State/Federal/Other certified Minority Business Enterprise?
Yes
No
If yes, please provide your:
State MBE certification number: ____________________________________________
Federal 8(a)/SDB certification number: _______________________________________
Identify who the other issuer is and the other certification number: __________________
Respondent is a publicly held entity or other organization not classifiable as owned by
individuals of a particular gender, race, ethnicity, or veteran status: Yes
No
If the Applicant is an individual:
Is the Applicant Female?
Yes
No
Is the Applicant of Hispanic or Latino origin?
Yes
No
Which of the following categories describes the Applicant (multiracial respondents may
select all applicable racial categories):
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
FOR DEPARTMENT USE ONLY:
Respondent Name:____________
Date:___________
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