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Enterprise Zone Interest Tax Credit LIC - Indiana
| Enterprise Zone Interest Tax Credit Form. This is a Indiana form and can be used in Enterprise Zones Department Of Revenue Statewide . |
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SCHEDULE LIC State Form 21926 (R9 / 8-12) Indiana Department of Revenue For Tax Year Ending: Month_________ Year _______ (Enclose completed schedule with annual state tax liability return.) Section A - Taxpayer Information Name of Taxpayer (lender) Street Address City or Town, State, and ZIP Code Enterprise Zone Loan Interest Tax Credit 814 Enclosure Sequence No. 28 Social Security or Federal Identification Number County Taxpayer's Telephone Number ( ) Borrower's Social Security or Federal Identification Number Borrower's Telephone Number Section B - Qualified Loan Information (attach list of all borrowers) Section B continued on reverse side. Name of Borrower (A) Street Address City or Town, State, and ZIP Code Use of Loan (check one): Date of Loan Origination: Location Name of Borrower's Enterprise Zone Business Personal Section C - Report of Qualified Loans to Businesses by Enterprise Zone Locations Summarize the number of qualified loans to businesses in each enterprise zone and the amount of interest received during the taxable year. Enterprise Zone Bedford Bloomington Connersville East Chicago Elkhart Evansville Ft. Harrison Ft. Wayne Frankfort Gary Grissom Aeroplex Hammond Indiana Army Ammunition Plant Indianapolis Subtotal (a) Number of Loans $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ (b) Interest Income Enterprise Zone (c) Number of Loans $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ (d) Interest Income Section D - Credit for Qualified Loans for the Taxable Year 1. Grand total of all qualified loans to businesses listed in Section C, columns (a) and (c) ............................ 1 $ 00 2 Total amount of loan interest income received from qualified loans in Section C, columns (b) and (d)........... 2 $ 00 3. Amount of loan interest income received from other qualified nonbusiness loans made for home improvements within all enterprise zones ................................................................................................... 3 $ 00 4. Total Loan Interest Credit - add amounts on lines 2 and 3; multiply result by 5 percent (.05) .................... 4 $ 00 5. Indicate for which tax type you are applying this credit. Enter net amount of tax you are offsetting: a Adjusted Gross Income Tax b Insurance Premium Tax c Financial Institutions Tax ....... 5 $ 00 The tax offset may not exceed the amount of available credit from line 4. Carry amount on line 5 to other credit line of your return. 6. Unused amount of credit available for carryover - subtract line 5 from line 4 and complete Section E ...... 6 $ 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 Jeffersonville Kokomo Lafayette La Porte Marion Michigan City Mitchell New Albany Portage Richmond Salem South Bend Terre Haute Vincennes Subtotal 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 *24100000000* 24100000000 American LegalNet, Inc. www.FormsWorkFlow.com Schedule LIC Page 2 Section B - Qualified Loan Information Continued (Attach additional sheets if necessary.) Name of Borrower (B) Borrower's Social Security or Federal Identification Number Street Address City or Town, State, and ZIP Code Use of Loan (Business or Personal): Name of Borrower (C) Street Address City or Town, State, and ZIP Code Use of Loan (Business or Personal): Name of Borrower (D) Street Address City or Town, State, and ZIP Code Use of Loan (Business or Personal): Date of Loan Origination: Location Name of Borrower's Enterprise Zone Date of Loan Origination: Location Name of Borrower's Enterprise Zone Borrower's Social Security or Federal Identification Number Borrower's Telephone Number Date of Loan Origination: Location Name of Borrower's Enterprise Zone Borrower's Social Security or Federal Identification Number Borrower's Telephone Number Borrower's Telephone Number Section E - Enterprise Zone Interest Credit Carryover (814) Enter the initial tax period in which the Enterprise Zone Loan Interest Credit was claimed. Enter the remaining unused amount of credit from Section D, line 6. Initial Tax Year Ending: Month ________________ Year_________ (1) Credit Carryforward 1st Following Tax Year 2nd Following Tax Year 3rd Following Tax Year 4th Following Tax Year 5th Following Tax Year 6th Following Tax Year 7th Following Tax Year 8th Following Tax Year 9th Following Tax Year 10th Following Tax Year Enterprise Zone Loan Interest Credit Available for Carryforward from Section D, Line 6: $_______________________________ (2) Total Amount of Tax (3) Type of Tax Liability Reduced (4) Amount Applied (5) Unused Credit Show how the unused credit is applied during the carryover period. Unused Credit (column 5) is to be placed on your return for the next tax year. Section F - Signature I certify I have examined this schedule and, to the best of my knowledge and belief, the information contained in this schedule is true, correct, and complete. Signature of Taxpayer: Title: Date Signed: *24100000000* 24100000000 American LegalNet, Inc. www.FormsWorkFlow.com Enterprise Zone LIC Instructions Indiana Code (IC) 6-3.1-7-2 provides that a taxpayer who is in good standing with the Indiana Economic Development Corporation is entitled to a state income tax credit of 5% of the interest income received from qualified loans made during the year. To qualify, the loan proceeds must be for purposes directly related to businesses located in an enterprise zone or for improvements increasing the assessed value of real property located in an enterprise zone.* A "qualified loan" also means a loan made to an individual or business that uses the loan proceeds toward the rehabilitation, repair, or improvement of a residence within an enterprise zone. *An enterprise zone created under IC 5-28-15 or an airport development zone (code # 802) designated under IC 8-22-3.5-14. Maps of enterprise zones and addresses can be found on the Web at www.in.gov/dor/3619.htm. Who May File for This Credit? For the purposes of eligibility, for the Loan Interest Credit, a taxpayer in good standing is defined as an entity conducting business operations within an enterprise zone that 1) Receives interest on a qualified loan made during the tax year; 2) Pays the registration fee charged to zone businesses under IC 5-28-15-5; 3) Provides the assistance to urban enterprise associations required from zone businesses under IC 5-28-15-5(b); and 4) Complies with any requirements adopted by the board of the Indiana Economic Development Corporation for taxpayers claiming the Enterprise Zone Loan Interest Credit. Note: If the taxpaye
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