A business that accesses at least one (1) tax credit or exemption shall submit this verified summary of the amount of the tax credits and exemptions claimed by the business in 2018 no later than June 1, 2019.  If a business cannot comply with this date, it must apply for an extension to the Association of Indiana Enterprise Zones (AIEZ) utilizing the approved EZB-E form postmarked no later than June 1, 2019.  If an extension is approved, this EZB-R form and fees must be submitted postmarked no later than July 15, 2019.

For questions, please contact the Fort Wayne Urban Enterprise Association, Inc. d/b/a SEED Fort Wayne:  AskSEEDFW@cityoffortwayne.org or call 260-422-2304.

  

INSTRUCTIONS FOR COMPLETING THE EZB-R

Part 1 General Information

Line 1: Enter legal name of the business.

Line 2: Enter the business telephone number (including area code). Line 3: Enter the mailing address of the business

Line 4: Enter the address of the business location in the enterprise zone/district or investment location. Line 5: Enter the social security number or the federal identification number of the business.

Line 6: Check the appropriate organizational form of the business. Line 7: Enter the e-mail address

Line 8: List the total number of employees at the zone/district location on the 15th of each month, add the column, divide by 12 and enter the number on line 8. Example for Line 8:

Date                                                Employees

Jan 15                                                   30

Feb 15                                                   30

Mar 15                                                   30

Apr 15                                                   30

May 15                                                  30

Jun 15                                                   45

Jul 15                                                    45

Aug 15                                                  45

Sep 15                                                  25

Oct 15                                                   25

Nov 15                                                  30

Dec 15                                                  30

Year Total                                          395

395 ÷ 12 = 32.9 Enter 32.9 on line 8

Line 9: List the total number of zone/district residents employed at the zone/district location of the 15th day of each month, divide the resulting figure by 12 and enter the number on line 9 (see example in line 8 instructions) Every participating business must complete this line, even if your business does not utilize the hiring tax credits.

Line 10:  Enter the total of all wages and salaries paid at the zone/district location for the calendar year for which you are filing.

Line 11:  Enter the total wages and salaries paid to zone/district resident employees at the zone/district location for the calendar year for which you are filing.

Line 12:  Enter the total number of Enterprise zone/district Qualified Employee Certificates (IT-40QEC) issued for the calendar year for which you are filing.

Line 13: Enter the total number of new jobs created at the zone/district location during the calendar year for which you are filing. Line 14:  Enter the total number of new jobs filled by zone/district residents during the calendar year for which you are filing.

Line 14: Enter the total number of new jobs filled by zone/district residents during the calendar year for which you are filing.

Part II Tax Savings Summary

If you are a new business or have no tax savings to report for the calendar year for which this form applies, please skip to part III of this form.

Line 15:  Enter the total Enterprise zone/district Investment Deduction

Line 15A:  Enter the total Tax Savings from the Enterprise Zone Investment Deduction

16: Enter the employment expense credit amount from Schedule EZ

Line 17:  Add the amounts of line 15A through line 16

Part III Registration Fee and Eligibility

Line 18: If the total on line 17, Part II exceeds $1,000, multiply the amount by .01 and enter that amount on this line.  If a zone/district business receives tax saving incentives in excess of $1,000 in any year, the business MUST pay an annual registration fee of one percent (1%) of its tax savings to the Association of Indiana Enterprise Zones, or be denied credits and incentives, and disqualified from further participation according to IC 5-28-15-7.  You must still submit an EZB-R even if your business does not owe a registration fee!    

REMIT THE AMOUNT ON THIS LINE WITH A COPY OF FORM EZB-R TO: 

                              ASSOCIATION OF INDIANA ENTERPRISE ZONES

                              P.O. BOX 1322

                              EVANSVILLE, IN 47706 

Line 19:  Multiply the amount on 17, Part II of this form by the local UEA rate (20%) and enter that amount on this line.  FORT WAYNE BUSINESSES WILL RECEIVE A SEPARATE INVOICE FOR ANY FEES DUE. DO NOT SEND A CHECK UNTIL INVOICED.

Line 20:  New Capital Investment for the Calendar Year

A. Enter the total dollar amount spent in the calendar year for zone/district business renovation and improvements at the zone location.

B. Enter the total dollar amount spent in the calendar year for new manufacturing equipment at the zone/district location.

C. Enter the total dollar amount spent in the calendar year for new research and development equipment at the zone/district location.

D. Enter the total dollar amount spent in the calendar year for new logistical distribution equipment at the zone/district location.

E. Enter the total dollar amount spent in the calendar year for new information technology equipment at the zone/district location.

Line 21:  Enter the amount of zone/district resident employee wages for the calendar year that exceeds each taxpayer’s base period qualified wages AND/OR the total dollar amount spent on employee training.

Line 22:  Add lines 18,19, 20A-20E, and 21 and enter that amount on this line.

Signature Lines

Corporate/firm officer must sign this form and print name below written signature. Failure to sign and print name and title may delay processing and may result in your form being returned to you. If someone other than the corporate/firm officer prepared this form, their name, signature, address and telephone number are required.

1) This form is an application for an extension of time to file form EZB-R (Enterprise Zone Business Registration Form).  The Association of Indiana Enterprise Zones (AIEZ) may grant an extension of not more than forty-five (45) days to file the EZB-R.  A zone/district business must apply for an extension to the AIEZ on this form POSTMARKED NO LATER THAN June 1, 2019