New Jobs Creation Tax Credit

New Jobs Creation Tax Credit
NAME OF BUSINESS:*
Federal ID number*
Contact Person*
Title*
Mailing Address*
Telephone Number*
Email address*
example@example.com
PROPERTY ADDRESS:
Property Address*
Name of Property Owner*
Address of Property Owner (if different than above): If leasing please answer b.) & c.) below.
a.*

OwnLease
b. How long is the lease?
c. Who is responsible for paying the property tax bill?*
Property Tax Account Number*
PROJECT DESCRIPTION:
Please provide a brief description of the project including the new square footage of the property*
Please provide an estimate of the total cost of personal property the business entity will report on its Maryland personal property return for the application tax year. *
$
EMPLOYEE INFORMATION:
If applicable number of full time positions in Carroll County prior to project*
Number of full time employee new hires as a result of the project must hire within 24 months of occupying new premises and pay 125 of average weekly wage per worked as determined by Maryland Department of Labor Licensing and Regulation (DLLR)*
Average pay rate annual or hourly for new jobs*
I certify that I am authorized to act on behalf of the above applicant and solemnly affirm under the penalties of perjury that the above information is true and correct. I understand the applicant must submit documentation reasonably necessary to verify the above including, but not limited to, a use & occupancy permit at time of issuance, payroll records, employee time sheets and such other documentation necessary to verify the above information for the taxable year for which the credit is sought and for the three taxable years following the last year in which a tax credit was granted. I further understand that submission of a false or fraudulent application or the withholding of information to obtain a tax credit is a violation and further subjects the application to repayment of all taxes with interest and penalties and expenses in the event a civil action for collection is filed.
Authorized Company Representative Print Name*
Title*
Signature*

Clear
Date*

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Date
Should be Empty:

New Jobs Creation Tax Credit

PROPERTY ADDRESS:

PROJECT DESCRIPTION:

EMPLOYEE INFORMATION: