"Application for Preliminary Certification - One Maryland Tax Credit" - Maryland

Application for Preliminary Certification - One Maryland 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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One Maryland Tax Credit
Application for Preliminary Certification
General Information About the Applicant:
1) Business Name:
2) Business Address:______________________________________________________________________
______________________________________________________________________
3) (a) FEIN:
3) (b) UI Number:
4) Type of Entity (corp., LLC, etc.)
5) (a)Business NAICs Code:
5) (b) Facility NAICs Code (if different):
Insurance
Financial Institution
Income Tax
6) Do you pay:
Premiums Tax
Franchise Tax
7) Facility Address: _______________________________________________________________________
_______________________________________________________________________
Project Information
8) Intent Date:
9) Effective Date of Start-up or Expansion:
10) County Project is located in:
11) Located in a PFA (please check all that apply):
State Enterprise Zone
Federal Empowerment Zone
Inside the I-495 or I695 Beltways
Sustainable Community
Incorporated Municipality
County Designated PFA
12) Beginning Date of Project Acquisition,
13) Date Project is Complete:
Installation or Construction:
14) Is the Project:
New Facility
Expansion
15) (a) Are you moving from one
From Where to Where?
Yes
No
location in Maryland to another
(see instructions)?
15) (b)Are you moving from outside Maryland? If so, from where:
16) Are You
Constructing a
Expanding an
Leasing a Facility
(see instructions)
New Facility
Existing Facility
Purchasing an
Other
Existing Building
17) If you are leasing space, how will project
Cash
Through the lease
costs be paid (see instructions)
1
One Maryland Tax Credit
Application for Preliminary Certification
General Information About the Applicant:
1) Business Name:
2) Business Address:______________________________________________________________________
______________________________________________________________________
3) (a) FEIN:
3) (b) UI Number:
4) Type of Entity (corp., LLC, etc.)
5) (a)Business NAICs Code:
5) (b) Facility NAICs Code (if different):
Insurance
Financial Institution
Income Tax
6) Do you pay:
Premiums Tax
Franchise Tax
7) Facility Address: _______________________________________________________________________
_______________________________________________________________________
Project Information
8) Intent Date:
9) Effective Date of Start-up or Expansion:
10) County Project is located in:
11) Located in a PFA (please check all that apply):
State Enterprise Zone
Federal Empowerment Zone
Inside the I-495 or I695 Beltways
Sustainable Community
Incorporated Municipality
County Designated PFA
12) Beginning Date of Project Acquisition,
13) Date Project is Complete:
Installation or Construction:
14) Is the Project:
New Facility
Expansion
15) (a) Are you moving from one
From Where to Where?
Yes
No
location in Maryland to another
(see instructions)?
15) (b)Are you moving from outside Maryland? If so, from where:
16) Are You
Constructing a
Expanding an
Leasing a Facility
(see instructions)
New Facility
Existing Facility
Purchasing an
Other
Existing Building
17) If you are leasing space, how will project
Cash
Through the lease
costs be paid (see instructions)
1
One Maryland Tax Credit Application for Preliminary Certification
18) Projected Job and Wage Information:
Year
Total
Qualified
Positions per
Year
Aggregate
Annual
Wages ($)
19) All Projected Jobs Pays at Least 120% of State Minimum Wage:
Yes
No
20) Describe Project and Project Costs:_______________________________________________________
________________________________________________________________________________________
21) Projected Project Costs
Year
Total
Eligible
Project Costs
($)
22) Type of activity business is “primarily engaged in” at business facility (check all that apply)
Manufacturing
Forestry/Fishing
Biotechnology
Mining
Research
Central Financial Services
Transportation
Development
Central Real Estate Services
Communication
Testing
Central Insurance Services
Public Utility
Computer Related Services
Company Headquarters
Warehousing/Distribution
Computer Programming
Central Administrative Offices
Agriculture
Data Processing
Business Services
Filmmaking
Resort
Recreation Business
23) Description of Activities Performed and Products Produced at Facility:__________________________
________________________________________________________________________________________
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One Maryland Tax Credit Application for Preliminary Certification
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 One
Maryland 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
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.
Audit: I understand that my application may be subject to a review by Commerce’s internal audit Department
and that additional information may be requested. Commerce’s Internal Audit office reviews a random sample
of Final Applications submitted annually.
Please return this form to:
Mark A. Vulcan
Program Manager, Tax Incentives
One Maryland Tax Credit Program
Maryland Department of Commerce 401 East Pratt Street, 17 th floor
Baltimore, Maryland 21202
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One Maryland Tax Credit Application for Preliminary Certification
THE FORM MUST BE SIGNED BY AN OWNER OR OFFICER OF THE BUSINESS ENTITY THAT CLAIMED
THE CREDITS.
I verify that the business applying for Certification (1) is current in all State and local tax obligations; (2) is not
in default in any State or local contract; (3) is in good standing and authorized or registered to do business in
the State.
Under penalties of perjury, I declare that the information contained in this application, to the best of my
knowledge and belief, it is true, correct and complete.
Name
Title
Signature
Date
Contact Name:
Contact Title:
Contact Phone:
Contact Email:
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One Maryland Tax Credit Instructions for the Preliminary Application
Below are instructions for filling out the One Maryland Tax Credit Preliminary Application. The instructions are
guidelines. You may download the One Maryland statute and regulations from the Maryland Department of
Business and Economic Development’s (Commerce) website at:
http://commerce.maryland.gov/fund/programs-for-businesses/one-maryland-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, of the facility that will be creating the new positions. More information on NAICS codes can
be found at:
http://www.census.gov/eos/www/naics/
6) Check off the type of tax the business entity pays.
7) Provide the address of the facility that where the entity will be incurring the eligible project costs and
creating the new positions.
Project Information
8) Provide the date that the business declared its intent to claim the One Maryland Tax Credit. A business
may only count project costs incurred and new qualified positions created after the intent date.
9) Provide the effective date of the start-up or expansion.
10) Provide the county that the project is located in. The project must be in a “Tier 1 County” to qualify.
This is subject to change; please verify with Commerce that the county your facility is located in is a
Tier 1 County.
11) The project must be located in a Priority Funding Area (PFA). Check off all areas that apply.
12) Provide the date that the business plans to begin the project. This includes purchasing land, beginning
construction, etc. The business has 12 months from its intent date to start the project.
13) Provide the date that the project will be complete. A business has three years from when it begins the
project to complete it.
14) Check if the project will be a new facility or the expansion of an existing facility.
15) a) Check Yes or No if the facility is moving from one location in Maryland to another and if yes, indicate
from where to where. b) If the business is moving from outside Maryland, indicate from where. If the
business moved from outside a One Maryland jurisdiction into one, the Secretary of Commerce must
determine that the project did not have a deleterious effect on the jurisdiction the business left and if
it qualifies for One Maryland.
16) Check whether the project is new construction, expansion, purchase of existing building or leasing an
existing building. If the eligible project costs include the purchase of an existing building, the Secretary
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