Form F-1158Z Fillable Enterprise Zone Property Tax Credit with Instructions R.08/13
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

$ $ $ (a) Florida health maintenance organization credit (a) $ (a) Throughout the current tax year for which the credit is claimed 1 (a) (a) Throughout the current tax year for which the credit is claimed 2 (a) (b) Capital investment tax credit (b) $ (b) Throughout the tax year preceding the tax year that the credit was (b) Total number of full time permanent employees at the business location (b) (b) Unused credit carryover available from prior tax years from Line 9 (b) $ (c) Divide Line (a) by Line (b) and enter here to determine whether the (c) Enterprise zone jobs credit (c) $ (c) Total number of additional full time employees throughout the current (d) Community contribution tax credit (d) $ (d) To qualify for the credit Line (c) must be five or more (Limited to $25 000 or $50 000 ) Ad Valorem Tax on: Date of Payment (see instructions) Ad Valorem Tax Paid Date Signature of Enterprise Zone Coordinator Title Date Signature of Officer Title Enter amount on Florida Form F 1120 Schedule V 15 $ For Calendar Year For Each Location (attach list) initially granted (b) location who are residents of an enterprise zone (attach listing) order of time (see instructions) Other taxable year beginning and ending tax year for which the credit is claimed: Line (a) minus Line (b) (c) Total number of full time employees employed at the business location: Total number of full time employees employed: Total other credits against the tax [add Lines (a) through (d)] 11 $ was created unused credit intervening tax years available this year (a) Tax year the unused credit (b) Amount of the (c) Amount applied in (d) Balance of unused credit 1 ( ) New business location within an enterprise zone 10 Enter amount of total tax due from Florida Form F 1120 Page 1 Line 11 10 $ 11 Enter the following credits from Florida Form F 1120 Schedule V: 12 Tax liability limitation (subtract Line 11 from Line 10) 12 $ 13 (a) Credit allowable for ad valorem taxes paid this year from Line 7 (a) $ 14 Total amount of credit available this year [total of Lines 13(a) and 13(b)] 14 $ 15 Enterprise zone property tax credit (lesser of Line 14 or Line 12) 2 ( ) Expansion of an existing business location within an enterprise zone 3 ( ) Rebuilding of an existing business located in an enterprise zone 4 ( ) (a) Number of full time permanent employees employed at the business 4 (a) 5 Real Property $ 6 Tangible Personal Property 7 Total (add Lines 5 and 6) $ 8 Enter below the amount of unused credit carryover from each of the five preceding tax years in 9 Total amount of unused credit carryover available this tax year $ Address of Location (attach separate list for each location) An enterprise zone property tax credit is authorized upon an affirmative demonstration by the taxpayer and belief Attach to Business is a small business as defined business meets the 20% criteria (c) by section (s ) 288 703 Florida Statutes (F S ) Effective 01/14 Enter below the amount of ad valorem taxes paid this year Attach copies of the validated receipts for the ad valorem taxes paid Enterprise Zone Property Tax Credit F 1158Z Federal Employer Identification Number (FEIN) Enterprise Zone Identifying Numbers Florida Administrative Code Form F 1120 have been met I certify that this Application contains the information required in section 220 182 F S and meets the criteria established as eligible to Income Tax Return) Name (As shown on your Florida Form F 1120 Corporate Part I Qualification for credit (see instructions) Part II Credit allowable for ad valorem taxes paid this year (see instructions) Part III Unused credit carryover from prior tax years (see instructions) Part IV Tax liability and tax year limitation (see instructions) Part V Enterprise zone property tax credit for this year (see instructions) R 08/13 receive an enterprise zone property tax credit Rule 12C 1 051 this year (see instructions) to the satisfaction of the Florida Department of Revenue that the requirements of section 220 182 F S Under penalties of perjury I declare that I have read this Application and the facts stated in it are true to the best of my knowledge