Form 775N Fillable Nebraska Employment and Investment Growth Act Credit Computation (4/2004)
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(1) Sales for resale (wholesale sales) (2) Sales of tangible personal property assembled (3) Sales of tangible personal property used by the (line 1 divided by line 2) $ (line 1 minus line 5) $ (line 14 minus lines 15 16 and 17) 18 (line 2 on Schedule II) 17 (line 3 minus line 4) $ (line 3 multiplied by line 4) $ (line 6 of Worksheet A 2) $ (see instructions) 16 (see Worksheet B 2 in instructions) (for 1987 applications 1 A Is there a new location included in the project? YES NO 1 Base year The year immediately preceding the year during 1 Enter in the space provided each partner s shareholder s or beneficiary s name social security number or Nebraska identification 1 For First Year Only (check appropriate box) Application Entitlement Carryover 1 Taxable year ending (see instructions) 1 1 Total cost of qualified property incorporated into 1 Total cost of qualified property incorporated into or used 1 Total number of employee hours paid per week (full time part time overtime 1 Total number of employee hours paid per year (full time part time overtime holiday etc hours paid during current year) 1 1 Total taxable compensation paid to all employees employed 1 Total taxable compensation paid to Nebraska resident employees 10 Allowable investment credit of current taxable year (see 10 Allowable investment credit of current taxable year (see Worksheet C 2 in 10 Was the base year adjusted for the full time equivalent employees which worked for the new entity for 11 Total allowable credit of current taxable year (total of $ $ $ $ $ 11 Total allowable credit of current taxable year (total of lines 9 and 10) 11 $ $ $ $ 11 Was the investment placed in service prior to the date of acquisition excluded from the investment 1120 SN 1041N 1120N 1065N 1120NF 1040N 12 Amount of credit carried forward from previous year 12 12 and 13) 14 13 Amount of distributed credit received during the 13 Amount of distributed credit received during the current year 13 14 Total available credit in current year (total of lines 11 $ $ $ $ $ 14 Total available credit in current year (total of lines 11 12 and 13) 14 $ $ $ $ 15 Amount of credit taken in current year against income 15 Amount of credit taken in current year against income tax liability (enter amount 16 Amount of credit used to receive sales and use tax 16 Amount of credit used to receive sales and use tax refunds on other 17 Amount of credit distributed to partners S corporation 17 Amount of credit distributed to partners S corporation shareholders or 18 Ending balance of total credit to be carried forward to $ $ $ $ $ 18 Ending balance of total credit to be carried forward to following year s line 12 $ $ $ $ 1987 applications use Worksheet C 1) 3 2 Base year employee Any individual who was employed 2 Does the application include all locations in the state? YES NO 2 Number of full time equivalent employees per week (divide line 1 2 Number of full time equivalent employees per year [divide line 1 amount by (40 times the number of weeks paid in year)] 2 2 Taxable compensation paid to base year employees at the 2 TOTAL (enter here and include on line 17 Form 775N) 2 Total average net annual lease/rent expense for 2 Total cumulative net investment in the project at taxable $ $ $ $ $ 2 Total cumulative net investment in the project at taxable year end (Qualified $ $ $ $ 2 Total full time equivalent employees for the current 3 Average compensation for current year 3 Compensation The wages and other payments subject 3 Current year investment of qualified property (net of sales 3 Current year investment of qualified property (net of sales tax paid) (line 5 from 3 Is the location interdependent with the prior project locations? YES NO 3 Total number of employee hours paid per week (full time part time overtime 3 Total number of employee hours paid per year (full time part time overtime holiday etc hours paid during base year) 3 3 Total taxable compensation paid (total of lines 1 and 2) $ 3 Total value of qualified property incorporated 4 A Less the amount of refundable Nebraska state 4 Has the controlling ownership of applicant changed? YES NO 4 Increase of base year employees in hours (as a result of employees who worked in Nebraska in the base year being 4 Increase of base year employees in hours (as a result of Nebraska 4 Number of new employees at taxable year end (see 4 Number of new employees at taxable year end (see Worksheet A 2 in 4 Taxable compensation paid to base year employees during 4 Total full time equivalent employees for base year 5 Excess compensation paid during the year 5 Investment amount of qualified property (line 3 minus 5 Is the applicant named in the Employment and Investment Growth Act agreement a corporation? YES NO 5 Taxable compensation paid in current year to non resident 5 Total number of employee hours paid per week after adjustment 5 Total number of employee hours paid per year after adjustment if any during base year (line 3 plus line 4) 5 5 Total refundable sales and use tax paid at the project $ $ $ $ $ 5 Total refundable sales and use tax paid at the project at year end (cumulative) 5 $ $ $ $ 6 Compensation credit for the current year (multiply 6 Does Paragraph 1 of the Employment and Investment Growth Agreement include unitary group 6 Enter in column A the last day of the calendar quarter 6 Enter in columns F through J the last day of each 6 Investment credit of current year (multiply line 5 by 10 6 Number of full time equivalent employees per week (divide line 5 6 Number of full time equivalent employees per year [divide line 5 amount by (40 times the number of weeks paid in year)] 6 6 Total eligible current year compensation paid 7 Average compensation paid to base year employees 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 7 Was there a purchase of the assets of another business? YES NO 8 Average annual wage per employee for jobs created $ $ $ $ 8 Average annual wage per employee for jobs created $ $ $ $ $ 8 Excess compensation paid during the year (line 6 8 Is there a new corporation joint venture limited liability company or partnership that is doing business 9 A Is the entity owned at least fifty percent by corporate members of the unitary group? YES NO 9 Allowable compensation credit of current taxable year $ $ $ $ $ 9 Allowable compensation credit of current taxable year (see Worksheet B 2 in $ $ $ $ 9 Compensation credit for the current year (multiply 9 Qualifying business Any business engaged in the a The conducting of research development or testing for acquisition by the taxpayer of a company eligible for inclusion in the amount by 40) and enter this amount on line 10 of Form 775N) $ and local option sales or use taxes included at the project (see definition of qualified property ) $ at the project for the current year $ at the project? YES NO at year end 5 Attach to Form 775N B Is the new business engaged in a qualifying activity? YES NO B Less the unpaid portion of canceled leases previously b The performance of data processing telecom munication B What is the new address? by the number of years of the lease for which C Is the entity unitary with the corporate members of the unitary group? YES NO c The assembly fabrication manufacture or calculations? YES NO certain fiduciary beneficiaries (line 2 on Schedule II) 17 claimed as investment $ current year 13 d The storage warehousing distribution or trans portation date (see instructions) 7 Describe the activity: e The sale of tangible personal property if more than 20 employees being transferred to and employed at the project or the employees hired after the base year $ following year s line 12 (line 14 minus lines 15 16 and 17) 18 For 1987 applications the average number of employees is For applications filed after January 1 1988 the annual average For companies acquired by the taxpayer after the year of For qualified property rented by the taxpayer the average net Form 775N) $ here and on appropriate line of Form 3800N) 15 holiday etc hours paid during the week which included the day listed above) if any (including the day listed above line 3 plus line 4) If Different Than If No it is not necessary to complete the rest of this section If Yes please explain If Yes please identify If Yes please identify owners and percent of ownership in Nebraska after the application date 8 in the line 3 amount $ in the project see definition of base year employee on page 6) 4 instructions) (for 1987 applications use Worksheet A 1) 4 instructions) (for 1987 applications use Worksheet B 1) 9 instructions) (for 1987 applications use Worksheet C 1) 10 into or used at the project (total of lines 1 and 2) $ line 3 of Form 775N) $ line 5 amount by 05 and enter on line 9 of line 8 amount by 05 and enter on line 9 Form 775N) $ lines 9 and 10) 11 members? YES NO minus line 7) $ Name as Shown on Return Social Security or Nebraska I D No Federal Identification Number Type of Return NOTE: If the response to line 7 includes more than one entity please attach a schedule which provides a response to questions of Form 3800N) 15 or the average of the total compensation paid during or used at the project (see definition of qualified other than base year employees while employed paid to base year employees during the base year Please complete questions 9 through 11 of this section and questions 5 and 6 of Section 2 Please complete questions 9B 10 and 11 of this section and questions 5 and 6 of Section 2 prior to the application date and in columns B through E project for the current year $ Project Location Project Number Project Name Year of Application Option Chosen in Employment and Investment Growth Act Agreement project see definition of base year employee on page 6) property ) $ property placed in service on or after the date of application net of: sales tax property used at the project (see instructions) 16 qualified property and expired or cancelled qualified leases) 2 qualified property leased/rented by the taxpayer for refunds on other property used at the project Required for any project with application filed after April 30 1996 retirements of qualified property and expired or cancelled qualified leases) 2 Schedule I is required for all projects with applications filed after April 30 1996 shareholders or certain fiduciary beneficiaries tax liability (enter amount here and on appropriate line tax paid) (line 5 from Worksheet C 2 in instructions) (for tax year 6 Taxable year beginning and ending Taxable year ending (see instructions) 1 taxpayer was originally bound not to exceed ten the 12 month period of time prior to the date of acquisition? YES NO the base year (enter the amount of compensation the base year and the two preceding years the date of application net of: sales tax retirements of the last day of each subsequent tax year 6 the number of years of the lease for which taxpayer the total of lines 4A and 4B) (Enter amount here and on transferred to and employed at the project or the acquisition by the taxpayer of a company eligible for inclusion use at the project (multiply average net annual rent use at the project (multiply average net annual rent by use Worksheet A 1) 4 use Worksheet B 1) 9 was originally bound not to exceed ten years) $ whichever is earlier) $ whichever is greater) $ Worksheet A 2 in instructions) (for 1987 applications Worksheet C 1) 10 Worksheet C 2 in instructions) (for 1987 applications use Worksheet C 2 in instructions) (for 1987 applications use Worksheet C 1) 3 year (line 2 of Worksheet A 2) $ year end (Qualified property placed in service on or after years or 3 years past end of entitlement period Yes No $10 000 000 investment and 100 new employees $20 000 000 investment $3 000 000 investment and 30 new employees (If corrected (If corrected (If corrected (If corrected (If corrected (lines 1 through 21) (Revenue Ruling 29 87 11) or (b) property that is rented by * NOTE: Each partner S corporation shareholder and beneficiary should be notified of the distributed share of the credit reported on line 17 10 Qualified employee leasing company A qualified 11 Qualified property Any tangible property of a type subject 12 Taxpayer Any person subject to sales and use tax and 13 Year The taxable year of the taxpayer 1988 the average net annual rent is multiplied by the number 4 Entitlement period The year during which the required 5 Investment The value of qualified property incorporated 5 through 9 for each of the entities 6 Motor vehicle Any motor vehicle trailer or semitrailer as 7 Nebraska employee An individual who is either a resident 8 426 1987 Rev 5 2013 Supersedes 8 426 1987 Rev 4 2004 8 Number of new employees The excess of the average 87 11) or (b) property that is rented by the taxpayer qualifying Act must file the Nebraska Schedule I Estimated Sales and activities; or Addition of New Entity or Acquisition of Assets Addition of New Location to Project adjustment on line 4 of Worksheet A 1 or A 2 depending on amount less than 50 cents is to be rounded to the next lower dollar Amount of Credit and 401K contributions made by an employee are not and incidental to the leasing of a building is included in the and Sales Tax and that also grants to the client lessee input into hiring and and the next six years annual rent is multiplied by the number of years of the lease Any credit distributed by a partnership S corporation or estate or trust application for an agreement with the State Tax Commissioner APPLICATION OF CREDITS application the base year for the acquired company shall be application through the expiration of all incentives under the Act Application Year April 30 1996 under the Employment and Investment Growth are for purchases made after the year the required levels were are subject to such taxes as an attachment to the taxpayer s Nebraska income tax return at each date Use the number of actual people employed not full time at the project at the project Credit refunds are for purchases for use at the attach explanation) attach explanation) attach explanation) attach explanation) attach explanation) ATTACH THIS FORM TO NEBRASKA INCOME TAX RETURN ATTACH THIS PAGE TO YOUR NEBRASKA INCOME TAX RETURN ATTACH THIS PAGE TO YOUR NEBRASKA INCOME TAX RETURN ATTACH THIS PAGE TO YOUR NEBRASKA INCOME TAX RETURN attainment of the required levels immediately after the last day of Average of B Adjusted Base Year at Project C D and E cannot be claimed or paid until the year after the required levels Carryover period The next eight years after the end of the Change in Ownership of Project COLUMN C DIRECT REFUNDS Direct refunds are COLUMN D CREDIT REFUNDS Credit refunds are Columns A B Company Name compensation compensation received from the taxpayer or its predecessors computation connection with the project All purchases of qualified property corporation that is a member of the same unitary group which Corrected Corrected Corrected Corrected Corrected created in Nebraska after the application date Credit Computation Form 775N for each year from the filing of the credit on line 10 The taxpayer must meet both threshold levels of Credit Refunds Current Year at Project defined in section 60 301 and subject to licensing for operation DEFINITIONS depreciation amortization or other recovery under the Internal determined by converting into equivalent employees of 40 Direct Refund divided by (40 multiplied by the number of weeks in the year) dollars during the base year and who was employed at the project at Eighth Year 19 either an income tax imposed by the Nebraska Revenue Act employed at the project EMPLOYEE AND WAGE INFORMATION 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 Employment Calculation entitlement period entitlement period are eligible for refund The direct refunds Entitlement period The year during which the required equivalent employees Include all employees in Nebraska not just those equivalent employees the total number of hours paid per year exceeded and the next six years f The administrative management of any activities fabricated manufactured or processed by the seller Fifth Year 19 firing decisions A qualified employee leasing company does First First Year 19 following activities: following: for each year changed For Partnerships S Corporations and Certain Fiduciaries Only for purchases during a year cannot exceed the credit balance at for the current taxable year s Form 775N for use with Forms 1120N 1065N 1120 SN 1120NF 1041N and 1040N for which the taxpayer is initially bound not to exceed ten Form 775N Such notice will allow partners S corporation shareholders or beneficiaries to complete their Form 3800N Part C Fourth Fourth Year 19 g Any combination of the activities listed above Growth Act Credit Growth Act to another person hours per week the number of hours paid for the time periods However the taxpayer may elect to file the form reporting the initial in Nebraska and subject to the Nebraska income tax on in order to claim either compensation credit or investment credit including headquarter facilities relating to such including the first day of the year and the last day of each Income or Ownership increases in employment and investment were first met or increases in employment and investment were met or exceeded INSTRUCTIONS insurance or financial services; Internal Revenue Code of 1986 or components of such into or used at the project For qualified property owned by investing in qualified property of at least $3 million and the hiring Investment Growth Act Project is subject to such taxes and any partnership S corporation its unitary S corporation parent LAST DAY OF QUARTER Last Filed Amount liabilities LINE 1 If you have more than nine years to report you may start LINE 10 Use the following worksheet to calculate your line 10 entry: LINE 13 Enter the amount of distributed credit received during the LINE 16 Enter the amount of credit used to obtain refunds of sales and LINE 17 From line 2 Schedule enter the amount of credit distributed LINE 17 From line 2 Schedule II enter the amount of credit distributed LINE 4 Use the following worksheet to calculate your line 4 entry: LINE 5 Enter the total of sales and use taxes paid on the project at LINE 7 Enter the total number of employees employed in Nebraska LINE 8 Enter the estimated annual wage per new employee for jobs LINE 9 Use the following worksheet to calculate your line 9 entry: met both thresholds of investing $3 million and hiring 30 new employees met through the end of the carryover period Credit refunds moving expenses paid by the employer to the employee must be distributed to the partners shareholders or beneficiaries in the must file a Nebraska Employment and Investment Growth Act Name as Shown on Form 775N Project Name Nebraska Identification Number Name as Shown on Form 775N Project Name Nebraska Identification Number Date of Application Name of Partner NEBRASKA EMPLOYMENT AND INVESTMENT GROWTH ACT CREDIT COMPUTATION NEBRASKA EMPLOYMENT AND INVESTMENT GROWTH ACT CREDIT COMPUTATION Page 2 Nebraska I D No NEBRASKA SCHEDULE I Estimated Sales or Use Tax Refunds NEBRASKA SCHEDULE II Distribution of Employment and Investment NEBRASKA SCHEDULE III Changes Within Current Employment and necessary to correct previously reported years check the corrected box Ninth Year 19 not include (a) aircraft barges motor vehicles railroad rolling not include a temporary employment agency NOTE: A taxpayer must have signed an agreement and met the number of employees employed at the project during a year number of new employees is determined by converting into number share of income or ownership and distributed share of the credit reported on line 17 Form 775N (or attach a schedule of 1967 or a franchise tax under Chapter 77 article 38 any of at least 30 new employees by the close of the current taxable year of employment and investment are met In subsequent years of tangible personal property; of years for which the taxpayer is initially bound not to exceed on the highways or aircraft after the date of application through the end of the or franchise tax and sales tax or industrial purposes; or joint venture when the partners shareholders or members or partial year resident of Nebraska order to claim a compensation credit on line 9 and an investment over the average number of base year employees percent of the total sales are in any combination of the period whichever is earlier The rental of land included in person processing of tangible personal property; Project Name project that are not eligible for direct refunds Credit refunds property does not include: (a) aircraft barges motor vehicles property that will be located and used at the project Qualified providing the above information) In the last column indicate whether each partner shareholder or beneficiary is subject to income purchaser in any of the listed qualifying activities; QUALIFICATION LEVELS Qualified property Any type of property of a type subject to qualified property for use at the project or on aircraft for use in quarter of the year quarterly refund claims may be filed railroad rolling stock watercraft or computer software refunds of Nebraska sales and use taxes on purchases of refunds of Nebraska sales and use taxes using credits earned required levels of employment and investment for the project in Revenue Code of 1986 or components of such property that ROUND TO WHOLE DOLLARS Any amount from fifty cents same manner as income is distributed for use against their income tax scientific agricultural animal husbandry food product Second Second Year 19 SECTION 1: SECTION 2: SECTION 3: Seventh Year 19 Share of Shareholder or Beneficiary* Sixth Year 19 Social Security or Social Security or Nebraska I D No some time since the end of the year preceding the base year SPECIFIC INSTRUCTIONS FOR 1987 APPLICATIONS SPECIFIC INSTRUCTIONS FOR APPLICATIONS FILED AFTER JANUARY 1 1988 stock watercraft or computer software (Revenue Ruling 29 Subject to Income Tax Year in Which Refund is Made TAXABLE YEAR ten years or the end of the third year after the entitlement The amounts on the computation form must be shown in whole the beginning of the year the taxpayer qualifying under the Employment and Investment the taxpayer the value is the original cost of the property the twelve months preceding the year of acquisition Make the year of application the year the required levels were met Third Third Year 19 through 99 cents is to be rounded to the next higher dollar; and any to depreciation amortization or other recovery under the to partners S corporation shareholders or certain fiduciary beneficiaries to withholding for federal income tax purposes Normally Total Estimated Refunds under the Employment and Investment Growth Act to another Use Tax Refunds each year 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 WHEN AND WHERE TO FILE This computation must be filed which the application was submitted by the taxpayer WHO MUST FILE Any applicant who applied after WHO MUST FILE Any taxpayer who has filed a project 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 WORKSHEET B 1 Compensation Credits WORKSHEET B 2 Compensation Credits WORKSHEET C 1 Investment Credit WORKSHEET C 2 Investment Credit year end This is the cumulative balance of the sales and use taxes paid year For example a C corporation subsidiary could receive credits from Year The taxable year of the taxpayer years for 1987 applications For applications after January 1 your carryover period by checking the appropriate box If you find it your current report with the first year of your entitlement period or