Form 775N Nebraska Employment and Investment Growth Act Credit Computation

$ Eighth Year Corrected (If corrected attach explanation) Off $ Ninth Year Corrected (If corrected attach explanation) Off $ Seventh Year Corrected (If corrected attach explanation) Off 1 Corrected (If corrected attach explanation) First Year 1120 SN 1041NType of Return 1120N 1065N 1120NF 1040N OffOffOffOffOffOff Corrected (If corrected attach explanation) Second Year Date of Application Federal Identification Number FORM 775N Fourth Year Corrected (If corrected attach explanation) Nebraska Identification Number Option Chosen in Employment and Investment Growth Act Agreement $3 000 000 investment and 30 new employees $20 000 000 investment $10 000 000 investment and 100 new employees OffOffOff Project Name Third Year Corrected (If corrected attach explanation) Year of Application (A) First Day LAST DAY OF QUARTER (B) First (C) Second (D) Third (E) Fourth (see Worksheet B 2 in instructions) (for 1987 applications use Worksheet B 1) 10 Allowable investment credit of current taxable year (see 9 * NOTE: Each partner S corporation shareholder and beneficiary should be notified of the distributed share of the credit reported on line 17 Form 775N Such notice will allow partners S corporation shareholders or beneficiaries to complete their Form 3800N Part C 1 Application Year 1 Enter in the space provided each partner s shareholder s or beneficiary s name social security number or Nebraska identification number share of income or ownership and distributed share of the credit reported on line 17 Form 775N (or attach a schedule providing the above information) In the last column indicate whether each partner shareholder or beneficiary is subject to income or franchise tax and sales tax 1 Taxable year ending (see instructions) 2 Total cumulative net investment in the project at taxable year end (Qualified property placed in service on or after 1 $ $ Fifth Year Sixth Year Corrected (If corrected attach explanation) Corrected (If corrected attach explanation) Off 1 Total cost of qualified property incorporated into or used at the project (see definition of qualified property ) $ 2 Total average net annual lease/rent expense for qualified property leased/rented by the taxpayer for use at the project (multiply average net annual rent by the number of years of the lease for which taxpayer was originally bound not to exceed ten years or 3 years past end of entitlement period whichever is earlier) $ 3 Total value of qualified property incorporated into or used at the project (total of lines 1 and 2) $ 4A Less the amount of refundable Nebraska state and local option sales or use taxes included in the line 3 amount $ B Less the unpaid portion of canceled leases previously claimed as investment $ 5 Investment amount of qualified property (line 3 minus the total of lines 4A and 4B) (Enter amount here and on line 3 of Form 775N) $ 6 Investment credit of current year (multiply line 5 by 10 and enter this amount on line 10 of Form 775N) $ 1 Total cost of qualified property incorporated into or used at the project (see definition of qualified property ) $ 2 Total average net annual lease/rent expense for qualified property leased/rented by the taxpayer for use at the project (multiply average net annual rent by the number of years of the lease for which taxpayer was originally bound not to exceed ten years) $ 3 Total value of qualified property incorporated into or used at the project (total of lines 1 and 2) $ 4A Less the amount of refundable Nebraska state and local option sales or use taxes included in the line 3 amount $ B Less the unpaid portion of canceled leases previously claimed as investment $ 5 Investment amount of qualified property (line 3 minus the total of lines 4A and 4B) (Enter amount here and on line 3 of Form 775N) $ 6 Investment credit of current year (multiply line 5 by 10 and enter this amount on line 10 of Form 775N) $ 1 Total number of employee hours paid per week (full time part time overtime holiday etc hours paid during the week which included the day listed above) 2 Number of full time equivalent employees per week (divide line 1 amount by 40) 1 Total number of employee hours paid per year (full time part time overtime holiday etc hours paid during current year) 2 Number of full time equivalent employees per year [divide line 1 amount by (40 times the number of weeks paid in year)] 1 1 Total taxable compensation paid to all employees employed at the project for the current year $ 2 Total full time equivalent employees for the current year (line 2 of Worksheet A 2) $ 3 Average compensation for current year (line 1 divided by line 2) $ 4 Total full time equivalent employees for base year (line 6 of Worksheet A 2) $ 1 Total taxable compensation paid to Nebraska resident employees other than base year employees while employed at the project for the current year $ 2 Taxable compensation paid to base year employees at the project for the current year $ 3 Total taxable compensation paid (total of lines 1 and 2) $ 4 Taxable compensation paid to base year employees during the base year (enter the amount of compensation paid to base year employees during the base year or the average of the total compensation paid during the base year and the two preceding years whichever is greater) $ 5 Excess compensation paid during the year (line 3 minus line 4) $ 6 Compensation credit for the current year (multiply line 5 amount by 05 and enter on line 9 of Form 775N) $ 11 Total allowable credit of current taxable year (total of lines 9 and 10) 11 $ $ 12 Amount of credit carried forward from previous year 12 13 Amount of distributed credit received during the current year 13 14 Total available credit in current year (total of lines 11 12 and 13) 15 Amount of credit taken in current year against income 14 $ $ 18 Ending balance of total credit to be carried forward to following year s line 12 (line 14 minus lines 15 16 and 17) 18 $ $ 1A Is there a new location included in the project? YES NO B What is the new address? OffOff 2 Does the application include all locations in the state? YES NO 3 Is the location interdependent with the prior project locations? YES NO How? OffOffOffOff 2 TOTAL (enter here and include on line 17 Form 775N) 3 Total number of employee hours paid per week (full time part time overtime holiday etc hours paid during the week which included the day listed above) 4 Increase of base year employees in hours (as a result of Nebraska employees being transferred to and employed at the project or the acquisition by the taxpayer of a company eligible for inclusion in the project see definition of base year employee on page 6) 5 Total number of employee hours paid per week after adjustment if any (including the day listed above line 3 plus line 4) 6 Number of full time equivalent employees per week (divide line 5 amount by 40) 3 Total number of employee hours paid per year (full time part time overtime holiday etc hours paid during base year) 4 Increase of base year employees in hours (as a result of employees who worked in Nebraska in the base year being transferred to and employed at the project or the acquisition by the taxpayer of a company eligible for inclusion in the project see definition of base year employee on page 6) 5 Total number of employee hours paid per year after adjustment if any during base year (line 3 plus line 4) 6 Number of full time equivalent employees per year [divide line 5 amount by (40 times the number of weeks paid in year)] 3 5 Is the applicant named in the Employment and Investment Growth Act agreement a corporation? YES NO If No it is not necessary to complete the rest of this section 6 Does Paragraph 1 of the Employment and Investment Growth Agreement include unitary group members? YES NO OffOffOffOff 5 Taxable compensation paid to non resident employees who are not base year employees for the current year $ 6 Total eligible current year compensation paid (line 1 minus line 5) $ 7 Average compensation paid to base year employees (line 3 multiplied by line 4) $ 8 Excess compensation paid during the year (line 6 minus line 7) $ 9 Compensation credit for the current year (multiply line 8 amount by 05 and enter on line 9 Form 775N) $ 6 Enter in column A the last day of the calendar quarter prior to the application date and in columns B through E the last day of each subsequent tax year 7 Total number of actual employees in Nebraska at each date (see instructions) 8 Average annual wage per employee for jobs created in Nebraska after the application date 6 (A) (B) (C) (D) (E) 6 Enter in columns F through J the last day of each tax year 6 (F) (G) 7 Number of new employees at taxable year end (line 2 col F minus line 6 col F) Enter amount here and on line 4 Form 775N 7 Number of new employees at taxable year end (line 2 minus line 6) Enter amount here and on line 4 Form 775N 7 7 Total number of actual employees in Nebraska at each date (see instructions) 7 7 Was there a purchase of the assets of another business? YES NO If Yes please identify OffOff 8 426 1987 Rev 4 2004 Supersedes 8 426 1987 Rev 5 2002 8 Average annual wage per employee for jobs created in Nebraska after the application date 8 $ $ 9 Allowable compensation credit of current taxable year $ $ $ $ $ 9 Allowable compensation credit of current taxable year (see Worksheet B 2 in instructions) (for 1987 applications use Worksheet B 1) 10 Allowable investment credit of current taxable year (see Worksheet C 2 in instructions) (for 1987 applications use Worksheet C 1) 11 Total allowable credit of current taxable year (total of lines 9 and 10) 12 Amount of credit carried forward from previous year 13 Amount of distributed credit received during the current year 14 Total available credit in current year (total of lines 11 12 and 13) 15 Amount of credit taken in current year against income tax liability (enter amount here and on appropriate line of Form 3800N) 16 Amount of credit used to receive sales and use tax refunds on other property used at the project (see instructions) 17 Amount of credit distributed to partners S corporation shareholders or certain fiduciary beneficiaries (line 2 on Schedule II) 18 Ending balance of total credit to be carried forward to following year s line 12 (line 14 minus lines 15 16 and 17) 9 $ 9 Qualifying business Any business engaged in the following activities: A Tax Year in Which Refund is Made B Adjusted If Different Than Last Filed Amount C Direct Refund D Credit Refunds Act must file the Nebraska Schedule I Estimated Sales and and the next six years Any combination of the activities listed above APPLICAT ION OF CREDITS APPLICATION OF CREDITS April 30 1996 under the Employment and Investment Growth ATTACH THIS FORM TO NEBRASKA INCOME TAX RETURN ATTACH THIS PAGE TO YOUR NEBRASKA INCOME TAX RETURN Base Year at Project Base year employee Any individual who was employed in Nebraska and subject to the Nebraska income tax on compensation received from the taxpayer or its predecessors during the base year and who was employed at the project at some time since the end of the year preceding the base year Base year The year immediately preceding the year during which the application was submitted by the taxpayer Carryover period AThe next eight years after the end of the carryover period by checking the appropriate box If you find it necessary LINE 4 Use the following worksheet to calculate your line 4 entry: COLUMN C DIRECT REFUNDS A Direct refunds are refunds of Nebraska sales and use taxes on purchases of qualified property for use at the project or on aircraft for use in connection with the project All purchases of qualified property or aircraft after the date of application through the end of the entitlement period are eligible for refund The direct refunds cannot be claimed or paid until the year after the required levels of employment and investment are met In subsequent years quarterly refund claims may be filed COLUMN D CREDIT REFUNDS A Credit refunds are refunds of Nebraska sales and use taxes using credits earned at the project Credit refunds are for purchases for use at the project that are not eligible for direct refunds Credit refunds are for purchases made after the year the required levels were met through the end of the carryover period Credit refunds for purchases during a year cannot exceed the credit balance at the beginning of the year Company Name Compensation The wages and other payments subject to withholding for federal income tax purposes Normally moving expenses paid by the employer to the employee and 401K contributions made by an employee are not compensation current report with the first year of your entitlement period or your year changed Current Year at Project DEFINITIONS depreciation amortization or other recovery under the Internal EMPLOYEE AND WAGE INFORMATION Employment Calculation TAXABLE YEAR (F) Average of Columns A B C D and E entitlement period Entitlement period The year during which the required Entitlement period The year during which the required increases in employment and investment were first met or exceeded and the next six years For 1987 applications the average number of employees is determined by converting into equivalent employees of 40 hours per week the number of hours paid for the time periods including the first day of the year and the last day of each quarter of the year For applications filed after January 1 1988 the annual average number of new employees is determined by converting into equivalent employees the total number of hours paid per year divided by (40 multiplied by the number of weeks in the year) For companies acquired by the taxpayer after the year of application the base year for the acquired company shall be the twelve months preceding the year of acquisition Make adjustment on line 4 of Worksheet A 1 or A 2 depending on the year of application For qualified property rented by the taxpayer the average net annual rent is multiplied by the number of years of the lease for which the taxpayer is initially bound not to exceed ten years for 1987 applications For applications after January 1 1988 the average net annual rent is multiplied by the number of years for which the taxpayer is initially bound not to exceed ten years or the end of the third year after the entitlement period whichever is earlier The rental of land included in and incidental to the leasing of a building is included in the computation increases in employment and investment were met or exceeded INSTRUCTIONS Investment The value of qualified property incorporated into or used at the project For qualified property owned by the taxpayer the value is the original cost of the property LINE 1 If you have more than nine years to report you may start your to correct previously reported years check the corrected box for each LINE 10 Use the following worksheet to calculate your line 10 entry: LINE 13 Enter the amount of distributed credit received during the year For example a C corporation subsidiary could receive credits from its unitary S corporation parent LINE 16 Enter the amount of credit used to obtain refunds of sales and use taxes paid by the taxpayer on non qualified property purchased and used at the project after the end of the taxable year in which the taxpayer met both thresholds of investing $3 million and hiring 30 new employees LINE 17 From line 2 Schedule II enter the amount of credit distributed to partners S corporation shareholders or certain fiduciary beneficiaries Any credit distributed by a partnership S corporation or estate or trust must be distributed to the partners shareholders or beneficiaries in the same manner as income is distributed for use against their income tax liabilities LINE 5 Enter the total of sales and use taxes paid on the project at year end This is the cumulative balance of the sales and use taxes paid at the project LINE 7 Enter the total number of employees employed in Nebraska at each date Use the number of actual people employed not full time equivalent employees Include all employees in Nebraska not just those employed at the project LINE 8 Enter the estimated annual wage per new employee for jobs created in Nebraska after the application date LINE 9 Use the following worksheet to calculate your line 9 entry: Motor vehicle Any motor vehicle trailer or semitrailer as defined in section 60 301 and subject to licensing for operation on the highways Name as Shown on Form 775N Name as Shown on Form 775N Name as Shown on Return Social Security or Nebraska I D No Name of Partner Shareholder or Beneficiary* Social Security or Nebraska I D No Share of Income or Ownership Amount of Credit Subject to Income and Sales Tax nebrask a departmentof revenue NEBRA SKA SCHEDULE II Distribution of Employment and InvGrowth Act Credit For Partnerships S Corporations and Certain Fiduciaries Only estment FORM 775N nebrask a departmentof revenue NEBRASKA EMPLOYMENT AND INVESTMENT GROWTH ACT CREDIT COMPUTATION for use with Forms 1120N 1065N 1120 SN 1120NF 1041N and 1040N Schedule I is required for all projects with applications filed after April 30 1996 Taxable year beginning and ending nebrask a departmentof revenue NEBRASKA SC HEDULE III Changes Within Current Employment and Investment Growth Act Project FORM 775N nebrask a departmentof revenue Required for any project with application filed after April 30 1996 Attach to Form 775N 775N Nebraska employee An individual who is either a resident or partial year resident of Nebraska NEBRASKA EMPLOYMENT AND INVESTMENT GROWTH ACT CREDIT COMPUTATION Page 2 Nebraska Identification Number NEBRASKA SCHEDULE I Estimated Sales or Use Tax Refunds FORM not include (a) aircraft barges motor vehicles railroad rolling NOTE: A taxpayer must have signed an agreement and met the required levels of employment and investment for the project in order to claim a compensation credit on line 9 and an investment credit on line 10 The taxpayer must meet both threshold levels of investing in qualified property of at least $3 million and the hiring of at least 30 new employees by the close of the current taxable year in order to claim either compensation credit or investment credit for the current taxable year's Form 775N NOTE: If the response to line 7 or 8 includes more than one entity please attach a schedule which provides a response to the required questions for each of the entities Number of new employees The excess of the average number of employees employed at the project during a year over the average number of base year employees OffOff OffOffOffOffOffOff person Please complete questions 9 through 11 of this section and questions 5 and 6 of Section 2 9A Is the entity owned at least fifty percent by corporate members of the unitary group? YES NO If Yes please identify owners and percent of ownership B Is the new business engaged in a qualifying activity? YES NO Describe the activity: C Is the entity unitary with the corporate members of the unitary group? YES NO 10 Was the base year adjusted for the full time equivalent employees which worked for the new entity for the 12 month period of time prior to the date of acquisition? YES NO 11 Was the investment placed in service prior to the date of acquisition excluded from the investment calculations? YES NO OffOff Please complete questions 9B 10 and 11 of this section 8 Is there a new corporation joint venture limited liability company or partnership that is doing business at the project? YES NO If Yes please identify OffOff printedonrecycledpaper ATTACH THIS FORM TO NEBRASKA INCOME TAX RETURN Project Location Project Name Project Name QUALIFICATION LEVELS Qualified employee leasing company A qualified employee leasing company is a company that places all employees of a client lessee on its payroll and leases such employees to the client lessee on an ongoing basis for a fee and that also grants to the client lessee input into hiring and firing decisions A qualified employee leasing company does not include a temporary employment agency Qualified property AAny type of property of a type subject to Qualified property Any tangible property of a type subject to depreciation amortization or other recovery under the Internal Revenue Code of 1986 or components of such property that will be located and used at the project Qualified property does not include: (a) aircraft barges motor vehicles railroad rolling stock watercraft or computer software (Revenue Ruling 29 87 11) or (b) property that is rented by the taxpayer qualifying under the Employment and Investment Growth Act to another person refunds on other property used at the project (see instructions) 17 Amount of credit distributed to partners S corporation 16 Revenue Code of 1986 or components of such property that ROUND TO WHOLE DOLLARS Any amount from fifty cents through 99 cents is to be rounded to the next higher dollar; and any amount less than 50 cents is to be rounded to the next lower dollar Sales for resale (wholesale sales) Sales of tangible personal property assembled fabricated manufactured or processed by the seller or Sales of tangible personal property used by the purchaser in any of the listed qualifying activities; SECTION 1: Addition of New Location to Project SECTION 2: Change in Ownership of Project 4 Has the controlling ownership of applicant changed? YES NO If Yes please explain OffOff SECTION 3: Addition of New Entity or Acquisition of Assets shareholders or certain fiduciary beneficiaries (line 2 on Schedule II) 17 Social Security or Nebraska I D No SPECIFIC INSTRUCTIONS FOR 1987 APPLICATIONS LINE 1 If you have more than nine years to report you may start your to correct previously reported years check the corrected box for each current report with the first year of your entitlement period or your year changed carryover period by checking the appropriate box If you find it necessary LINE 4 Use the following worksheet to calculate your line 4 entry: SPECIFIC INSTRUCTIONS FOR APPLICATIONS FILED AFTER JANUARY 1 1988 stock watercraft or computer software (Revenue Ruling 29 87 11) or (b) property that is rented by the taxpayer qualifying tax liability (enter amount here and on appropriate line of Form 3800N) 16 Amount of credit used to receive sales and use tax 15 tax paid) (line 5 from Worksheet C 2 in instructions) (for 1987 applications use Worksheet C 1) 4 Number of new employees at taxable year end (see 3 Taxable year ending (see instructions) 2 Total cumulative net investment in the project at taxable year end (Qualified property placed in service on or after the date of application net of: sales tax retirements of qualified property and expired or cancelled qualified leases) 3 Current year investment of qualified property (net of sales tax paid) (line 5 from Worksheet C 2 in instructions) (for 1987 applications use Worksheet C 1) 4 Number of new employees at taxable year end (see Worksheet A 2 in instructions) (for 1987 applications use Worksheet A 1) 5 Total refundable sales and use tax paid at the project at year end (cumulative) 1 For First Year Only (check appropriate box) Application Entitlement Carryover OffOffOff Taxpayer Any person subject to sales and use tax and either an income tax imposed by the Nebraska Revenue Act of 1967 or a franchise tax under Chapter 77 article 38 any corporation that is a member of the same unitary group which is subject to such taxes and any partnership S corporation or joint venture when the partners shareholders or members are subject to such taxes The administrative management of any activities including headquarter facilities relating to such activities; or The amounts on the computation form must be shown in whole dollars The assembly fabrication manufacture or processing of tangible personal property; The conducting of research development or testing for scientific agricultural animal husbandry food product or industrial purposes; the date of application net of: sales tax retirements of qualified property and expired or cancelled qualified leases) 3 Current year investment of qualified property (net of sales 2 The performance of data processing telecom munication insurance or financial services; The sale of tangible personal property if more than 20 percent of the total sales are in any combination of the following: The storage warehousing distribution or trans portation of tangible personal property; Total Estimated Refunds (lines 1 through 21) 22 $ under the Employment and Investment Growth Act to another Use Tax Refunds each year WHEN AND WHERE TO FILE This computation must be filed as an attachment to the taxpayer's Nebraska income tax return However the taxpayer may elect to file the form reporting the initial attainment of the required levels immediately after the last day of the year the required levels were met WHO MUST FILE A Any applicant who applied after WHO MUST FILE Any taxpayer who has filed a project application for an agreement with the State Tax Commissioner must file a Nebraska Employment and Investment Growth Act Credit Computation Form 775N for each year from the filing of the application through the expiration of all incentives under the Act will be located and used at the project Qualified property does WORKSHEET A 1 Full Time Equivalent Employees WORKSHEET A 2 Full time Equivalent Employees Current Year at Project Worksheet A 2 in instructions) (for 1987 applications use Worksheet A 1) 5 Total refundable sales and use tax paid at the project at year end 4 5 $ $ WORKSHEET B 1 Compensation Credits WORKSHEET B 2 Compensation Credits WORKSHEET C 1 Investment Credit Worksheet C 2 in instructions) (for 1987 applications use Worksheet C 1) 10 WORKSHEET C 2 Investment Credit Year AThe taxable year of the taxpayer Year The taxable year of the taxpayer Yes No