26 CAR pt. 67, Appendix A. AR1036 Tax Credit Documentation - Tuition Reimbursement Tax Credit Program

AR1036 TAX CREDIT DOCUMENTATION Tuition Reimbursement Tax Credit Program Section A. Tax Year Beginning _______________ and Ending _______________ Name of entity:________________________________________________________________ Address:_____________________________________________________________________ City, State, Zip Code:___________________________________________________________ FEIN/SSN:___________________________________________________________________ SIC CODE:___________________________________________________________________ Eligibility category (see backside, enter a letter A through H) ______________________. If category "B" or "D", enter the percentage of your total Sales that are outside the State of Arkansas ______________________. OWNERSHIP OF BUSINESS  Individual  Partnership (Complete Section C)  Taxable Corporation  LLC (Complete Section C)  Fiduciary  Subchapter-S (Complete Section C) Section B. Employee's Name* Tuition, books, & fees For Term Ending reimbursed to employee ($) ______________ (date) _______________ ______________________ __________________ _______________ ______________________ __________________ _______________ ______________________ __________________ _______________ ______________________ __________________ _______________ ______________________ __________________ _______________ ______________________ __________________ _______________ ______________________ __________________ Total Amount Reimbursed ______________________ Total Tax Credit = (total amount reimbursed x (0.30) = ____________________ *If more space is needed for employees' names, attach addition sheet(s) and enter the total amount reimbursed for all employees in the space immediately above. Section C. Owner's Name* Percentage of Social Security Proportionate Ownership Number Share of Credit* _______________ _________ ____________ _____________ _______________ _________ ____________ _____________ _______________ _________ ____________ _____________ _______________ _________ ____________ _____________ _______________ _________ ____________ _____________ _______________ _________ ____________ _____________ _______________ _________ ____________ _____________ *The credit should be allocated to each member based upon that member's share of the entity's net income and loss. A member 's proportionate share is generally equivalent to the member's percentage of ownership in the entity. Eligibility Categories. (A) Manufacturers classified in Federal Standard Industrial Classification (SIC) codes 20-39, including semiconductor and microelectronic manufacturers; (B) Computer businesses primarily engaged in providing computer programming services; the design and development of prepackaged software; businesses engaged in digital content production and digital preservation; computer processing and data preparation services; information retrieval services; computer and data processing consultants and developers. All businesses in this group must derive at least sixty percent (60%) of their revenue from out of state sales and have no retail sales to the general public; (C) Businesses primarily engaged in commercial physical and biological research as classified by SIC code 8731; (D) Businesses primarily engaged in motion picture production. All businesses in this group must derive at least 60% of their revenue from out of state sales and have no retail sales to the general public; (E) Distribution centers with no retail sales to the general public; (F) An office sector business with no retail sales to the general public; (G) A corporate or regional headquarters with no retail sales to the general public and; (H) A trucking/distribution terminal, as classified by SIC code 4231, with no retail sales to the general public.