Free 50468.FH11 - Indiana

2008 APPLICATION FOR EXTENSION OF TIME TO FILE INDIANA EZB-R
State Form 50468 (R4 / 1-09) Approved by State Board of Accounts, 2007 INDIANA ECONOMIC DEVELOPMENT CORPORATION (IEDC)

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FORM EZB-E

INSTRUCTIONS: 1. This form is an application for an extension of time to file Indiana form EZB-R (Enterprise Zone Business Registration form). The Indiana Economic Development Corporation may grant an extension of not more than forty-five (45) days to file the EZB-R. A zone business must apply for an extension to the Board on this form POSTMARKED NO LATER THAN June 1, 2009. 2. Please return this form with APPROVED stamped on it, if approved for an extension by the IEDC. 3. Attach the approved extension to the EZB-R. 4. The EZB-R registration form and fees MUST BE POSTMARKED NO LATER THAN July 15, 2009. Failure to file this form or EZB-R in a timely manner may result in monetary penalty, denial of tax savings, and disqualification from the program. 5. Mail to: Indiana Economic Development Corporation Indiana Enterprise Zone Program One North Capitol, Suite 700 Indianapolis, IN 46204-2288 INFORMATION ABOUT THE APPLICANT
Name of business Federal Identification number

Mailing address (number and street)

City

State

ZIP code

Zone address (number and street)

Zone city

Zone state

Zone ZIP code

Telephone number

(
TO BE COMPLETED BY THE APPLICANT

)

1. Total expected tax savings for calendar year 2008 2. Total fee you expect to owe the state this year 3. Total estimated new capital investment for calendar year 2008 4. Was an EZB-R filed last year Yes No
CERTIFICATION

$ $ $ If no, is this a first time filing? Yes No

Under penalties of perjury, I (we) declare that to the best of my (our) knowledge and belief, the statements made herein are true and complete.
Signature of firm or corporate officer Title

Name of firm or corporate officer (please print)

Date (month, day, year)