Schedule

EOTC-1                 Economic Opportunity Tax Credit
                                              (For periods AFTER January 1, 2015)
Rev. 10-15

                                                      Tax Year:
Beginning:                                                           Ending:

                   MM                         YYYY                               MM              YYYY
NAICS                                                          FEIN, TID, 
Code                                                              or SSN
Business Name: ___________________________________________________________________
Street Address: ____________________________________________________________________
________________________________________________________________________________
City, Town or Post O  ffice: ____________________________ State: _________  Zip Code_________
                                            Certi fied Multiple Year Projects
1. Investment Year(s): 1.                              2.                            3.

2. Investment Summary:                        Cost             Percentage            Quali fied
   Investment with Useful Life of 4-6 years                    x 33 ¹⁄  %
   Investment with Useful Life of 6-8 years                    x 66 ²⁄  %
   Investment with Useful Life of 8+ years                     x 100    %
   Total Quali fied Investment                                                  4.

                                                   New Jobs Percentage
   If number of new jobs created is at least [Small Business Only]        10           then                  10%
   If number of new jobs created is at least [Corp. Headquarters Only]    15           then                  10%
   If number of new jobs created is at least                              20           then                  20%
   If number of new jobs created is at least                              280          then                  25%
   If number of new jobs created is at least                              520          then                  30%
   Add 5% to new jobs percentage if you employ at least 75 full-time equivalent construction 
   workers at prevailing wage in $20 million or greater investment project.
3. Available Credit Calculation:
      Quali fied Investment                  X New Jobs Percentage    =    Tax Credit   X         10% / year

4. Pro-Rated Credit Allocation Summary at 10% per year for 10 years [Multiple year projects only]
   Year Available               Year 1             +   Year 2      +    Year 3   =               Total Credit
                                                   ++=
                                                   ++=
                                                   ++=
                                                   ++=
                                                   ++=
                                                   ++=
                                                   ++=
                                                   ++=
                                                   ++=
                                                   ++=
Schedule EOTC-1 — Rev. 10-15                                                                         Page 1 of 2

5. Annual New Jobs/Payroll Factor Computation              Number of Employees                    Payroll of Employees
   a. Pre-Credit Employment Levels:
      New-Jobs Employed for Credit:
      Total Employment in WV:
   b. Payroll Factor:        New Jobs Payroll                   Total WV Payroll                  Payroll Factor
                                                    /=
6. Annual Tax O ffset Factor:
   If Median compensation of new jobs is at least $40,198 (for 2015) then tax o ffset is 100%. Otherwise tax o ffset is 
   80%. Median compensation for this year is ______________________________. (See Administrative Notices for values 
   for other years.)

                                          TAX CREDIT APPLICATION COMPUTATION
7. A. Tax Subject to Credit O ffset

   Tax Type     Pre-Credit Liability      X Payroll Factor           X O ffset Factor     = Tax Subject to Credit O ffset
   B&O                                    XX=
   CNIT                                   XX=
   PIT*                                   XX=
   TOTAL                                  XX=
   B. Economic Opportunity Credit Applied
                                            Tax Subject to Credit          Tax Credit 
   Tax Type     Pre-Credit Liability        O ffset                         Applied         After Credit Net Tax
   B&O
   CNIT
   PIT*
   TOTAL
   * Individual Shareholders of S corporations and partnerships will also need to  file a Personal Income Tax credit schedule.
8. Tax Credit Recap
   a. Total credit pro-rated for this year
   b. Unused credit carryover from last year                                             +
   c. Total credit available this year                                                   =
   d. Total credit used this year (sum of “tax credit applied column of Section 7B)
   e. Credit remaining for carryover to next year (subtract amount on line 8d from the 
      amount on line 8c, and enter here [if the next year is year 13, enter $0])

Under penalties of perjury, I declare that I have examined this credit claim form (including accompanying schedules and 
statements) and to the best of my knowledge it is true and complete.

Signature of Taxpayer                     Name of Taxpayer (type or print) Title                             Date

Person to contact concerning this return                                   Telephone Number

Signature of Preparer other than Taxpayer Address                                                            Date

Schedule EOTC-1 — Rev. 10-15                                                                                     Page 2 of 2