Free DR-15ZC - Florida

Application for Florida Enterprise Zone Jobs Credit for Sales Tax

DR-15ZC R. 06/08

1. 2. 3.

Business Name _________________________________________________________________________________________________________________ Owner Name ___________________________________________________________________________________________________________________ Mailing Address _________________________________________________________________________________________________________________ City ____________________________________________________State _______________________________ ZIP ______________________________

4.

Business Location _______________________________________________________________________________________________________________ City ____________________________________________________State _______________________________ ZIP ______________________________

5. 6. 7. 8. 9a. 9b. 10. 11. 12.

Business Federal Employer I.D. # SalesTaxCertificate#

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Enterprisezoneidentificationnumberassignedpersection(s.)290.0065,FloridaStatutes(F.S.)inwhichabove businessislocated ....................................................................................................................................................................EZ Isthiszonedesignatedasaruralenterprisezone,pers.290.004(8)F.S.?................................................................................. YES Ifyes,completeScheduleTwoattached.Ifno,completeScheduleOneattached. Iseachemployee(person)listedonScheduleOneorTwoapermanentfull-timeemployeehiredtoperform dutiesinconnectionwiththeoperationsofthebusinessforanaverageofatleast36hoursperweek? .................................. YES Iseachemployee(person)listedonScheduleOneorTwoapermanent full-time employee leased from an employee leasingcompanylicensedunderChapter468,F.S.andhavetheybeencontinuouslyleasedtotheemployerforan averageofatleast36hoursperweekformorethansixmonthstoperformdutiesinconnectionwiththeoperationsof thebusinessforanaverageofatleast36hoursperweekeachmonththroughouttheyear? ................................................... YES Isthisa"smallbusiness"asdefinedins.288.703(1),F.S.?......................................................................................................... YES Arethenewemployees,forwhichthecreditisclaimed,participantsintheWelfareTransition Program(WTP)?Ifyes,completeScheduleThreeattached....................................................................................................... YES Computationoftheincreaseinpermanentfull-timejobsoverthe12monthspriortothedateofapplication: a. b. c. Enterthenumberofpermanentfull-timejobsonthedateofapplication: Enterthenumberofpermanentfull-timejobsonthedate12monthspriortothedateoftheapplication: Subtracttheamountonline12bfromtheamountonline12aandentertheresult: _________________________ _________________________ _________________________ NO

NO

NO NO NO

This application is due to the Department of Revenue within six months of the date of hire for the new employee(s) or within seven months of the date of hire for leased employee(s).Yourapplicationwillbedeniedifnotfiledontime.Anypersonwhofraudulentlyclaimsthecreditisliablefor repaymentofthecreditplusamandatorypenaltyof100percentplusinterest.Aftercertificationofthisapplicationbytheappropriateenterprisezone coordinator,mailthecompletedapplicationto: RETURNRECONCILIATION,FLORIDADEPARTMENTOFREVENUE,5050WESTTENNESSEEST,TALLAHASSEEFL32399-0129. NOTE: Your job credit(s) will expire 24 months after approval, provided the employee(s) remains employed for 24 months. Iherebyaffirmunderpenaltyofperjurythatallstatementsonthisdocumentaretrueandcorrecttothebestofmyknowledgeandbelief.

Signatureofowner,officer,orpartner

Printedname

Date

EnterpriseZoneCoordinatorCertificationSection Signature of Enterprise Zone Coordinator Printed name Date

Enterprise Zone Coordinator: Mail a copy of the completed application to the address above.

Schedule One ­ Enterprise Zone
Forabusinesstoqualifyforacreditof20percentoftotalwagespaidthey: · mustbephysicallylocatedinanenterprisezone, · havecreatednewjobs,and · havehiredneweligibleemployees.

DR-15ZC R. 06/08 Page 2

Entertheinformationrequestedbelowforeachqualifyingemployee.Thenumberofemployeesmaynotexceedthetotal listedonPage1,Line12c. Asanadditionalincentive,ifatleast20percentofALLpermanentfull-timejobsarefilledwithemployeesresidingin anenterprisezone,youqualifyforacreditof30percent.AttachaseparatelistofALLpermanentfulltime-employees, usingtheformatbelow. Name, Street Address, City and ZIP of Employee *Employee's Social Security Number Date Employed Monthly Wages
Enterprise Zone Number in which the Employee Resides

Total Monthly Wages
* Note:SocialsecuritynumbersareusedbytheFloridaDepartment ofRevenueasuniqueidentifiersfortheadministrationofFlorida's taxes.Socialsecuritynumbersobtainedfortaxadministration purposesareconfidentialundersections213.053and119.071, FloridaStatutes,andnotsubjecttodisclosureaspublicrecords.

$ (Makeadditionalcopiesifneeded)

Schedule Two - Rural Enterprise Zone
Forabusinesstoqualifyforacreditof30percentoftotalwagespaidthey: · mustbephysicallylocatedinaruralenterprisezone, · havecreatednewjobs,and · havehiredneweligibleemployeeswhoresideinaruralcounty. Entertheinformationrequestedbelowforeachqualifyingemployee.

DR-15ZC R. 06/08 Page 3

Asanadditionalincentive,ifatleast20percentofALLpermanentfull-timejobsarefilledwithemployeesresidingin anenterprisezone,youqualifyforacreditof45percent.AttachaseparatelistofALLpermanentfull-timeemployees, usingtheformatbelow.

Name, Street Address, City and ZIP of Employee

*Employee's Social Security Number

Date Employed

Monthly Wages

Rural County in which the Employee Resides

Total Monthly Wages
* Note:SocialsecuritynumbersareusedbytheFloridaDepartment ofRevenueasuniqueidentifiersfortheadministrationofFlorida's taxes.Socialsecuritynumbersobtainedfortaxadministration purposesareconfidentialundersections213.053and119.071, FloridaStatutes,andnotsubjecttodisclosureaspublicrecords.

$ (Makeadditionalcopiesifneeded)

Schedule Three ­ Welfare Transition Program
Forabusinesstoqualifyforcreditonwagespaidthey: · mustbephysicallylocatedinanenterprisezone, · havecreatednewjobs,and · havehiredneweligibleemployeeswhoareWelfareTransitionProgramparticipants. Thequalificationsforthepercentageofmonthlywagesclaimedforcreditareasfollows: · $4.00abovethehourlyfederalminimumwagequalifiesfor40percent. · $5.00abovethehourlyfederalminimumwagequalifiesfor41percent. · $6.00abovethehourlyfederalminimumwagequalifiesfor42percent. · $7.00abovethehourlyfederalminimumwagequalifiesfor43percent. · $8.00abovethehourlyfederalminimumwagequalifiesfor44percent. Name, Street Address, City and ZIP of Employee *Employee's Social Security Number Date Employed Actual Monthly Wages

DR-15ZC R. 06/08 Page 4

Indicate % Claimed 40, 41, 42, 43, or 44

Total Monthly Wages
* Note:SocialsecuritynumbersareusedbytheFloridaDepartment ofRevenueasuniqueidentifiersfortheadministrationofFlorida's taxes.Socialsecuritynumbersobtainedfortaxadministration purposesareconfidentialundersections213.053and119.071, FloridaStatutes,andnotsubjecttodisclosureaspublicrecords.

$ (Makeadditionalcopiesifneeded)