SCHEDULE                              WEST VIRGINIA TAX CREDIT FOR                                               West Virginia 
   SAAM-1                                FEDERAL EXCISE TAX IMPOSED UPON                                            State Tax Department
   REV10/2021                         SMALL ARMS AND AMMUNITION MANUFACTURERS
                                                             (FOR PERIODS ON OR AFTER JULY 1, 2021)
                                         SECTION A: BUSINESS IDENTIFICATION 
1  FEIN                                                                       WV TAX ID
                                                                     TAX PERIOD
2  BEGINNING                                                                  ENDING
                   MM                 DD                     YYYY                                  MM            DD YYYY
   BUSINESS NAME
3
   TAXPAYER NAME 
4

                                      SECTION B: COMPUTATION OF QUALIFIED INVESTMENT
ITEMIZED LISTING OF INVESTMENTS REQUIRED IF NOT SUBMITTED WITH APPLICATION (SAAM-A)
   INVESTMENTS THIS YEAR                                             A                                B             C 
                                                                     NET COST                      RATE             ALLOWABLE COST 
1  INVESTMENT WITH USEFUL LIFE OF                          $                                       33  ⅓%
   AT LEAST 4 YEARS BUT LESS THAN 6 YEARS
2  INVESTMENT WITH USEFUL LIFE OF                          $                                       66 ⅔%
   AT LEAST 6 YEARS BUT LESS THAN 8 YEARS
3  INVESTMENT WITH USEFUL LIFE OF 8 YEARS OR MORE          $                                          100% 
4  TOTAL QUALIFIED INVESTMENT FOR THIS TAX YEAR (SUM OF COLUMN 3)
   PRIOR YEAR QUALIFIED INVESTMENTS
5  REFERENCE PERIOD (# of             TAX PERIOD ENDING              A                                B             C 
   years prior to current tax period)                      ORIGINAL QUALIFIED INVESTMENT           ADJUSTMENTS *    NET QUALIFIED INVESTMENT
              9
              8
              7
              6
              5
              4
              3
              2
              1
   TOTAL PRIOR PERIOD QUALIFIED INVESTMENTS 
   * ADJUSTMENT, INCLUDING THE DISPOSAL OF PROPERTY OR MACHINERY BEFORE THE ORIGINALY STATED USEFUL LIFE, MAY ALSO RESULT IN THE RECAPTURE OF 
   CREDIT PREVIOUSLY CLAIMED.
6  TOTAL QUALIFIED INVESTMENT FOR 10 YEAR PERIOD (LINE 4 PLUS LINE 5)

                                      SECTION C: CALCULATION OF AVAILABLE CREDIT
7  FEDERAL EXCISE TAX PAID THIS TAX YEAR ATTTRIBUTABLE TO THE QUALIFIED INVESTMENT (TITLE 26 SECTION 4181 INTERNAL 
   REVENUE CODE)  COPIES OF FEDERAL FIREARMS AND AMMUNITION QUARTERLY EXCISE TAX RETURNS ARE REQUIRED
8  TAX CREDIT EARNED THIS TAX YEAR (IF THE AMOUNT ON LINE 6 IS EQUAL TO OR GREAT THAN $2 MILLION, ENTER AMOUNT ON 
   LINE 7; IF THE AMOUNT ON LINE 6 IS LESS THAN $2 MILLION ENTER “0”)
9  CURRENT YEAR TAX CREDIT AVAILABLE FOR USE THIS TAX YEAR (10% OF LINE 8)
10 TOTAL OF ANNUAL CREDITS EARNED IN PRIOR PERIODS (SECTION E, LINE 29, COLUMN A) 
11 PRIOR PERIOD UNUSED CREDIT CARRIED FORWARD TO THIS TAX YEAR  (COMPLETE SECTION D) 
12 TOTAL AVAILABLE CREDIT FOR THIS TAX PERIOD ( SUM OF LINES 9, 10, AND 11)
13 MAXIMUM AMOUNT OF CREDIT AVAILABLE FOR USE (OR DISTRIBUTION) THIS TAX YEAR (LOWER OF LINE 7 OR LINE 12)

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    SCHEDULE SAAM-1 (continued) 

                                      SECTION D: APPLICATION OF CREDIT
14  TAXABLE INCOME OF ENTITY WHICH EARNED THE CREDIT BEFORE OTHER ALLOWABLE CREDITS
15  QUALIFIED INVESTMENT APPORTIONMENT FACTOR ( WAGES ATTRIBUTABLE TO INVESTMENT/ALL WV WAGES)
    WAGES ATTRIBUTABLE TO                                 ALL WEST VIRGINIA WAGES
    INVESTMENT
16  TAXABLE INCOME ATTRIBUTABLE TO QUALIFIED INVESTMENT (LINE 14 MULTIPLIED BY LINE 15)
17  BUSINESS CALCULATION OF TAX ATTRIBUTABLE TO INVESTMENT ( LINE 16 MULTIPLIED BY WV TAX RATE)
18  MAXIMUM ALLOWABLE CREDIT OFFSET (LOWER OF LINE 17 OR LINE 13)
19  CORPORATION NET INCOME TAX CREDIT CLAIMED
20  PERSONAL INCOME TAXPAYER’S OWNERSHIP PERCENT
21  MAXIMUM AMOUNT OF CREDIT AVAILABLE FOR USE (LINE 13 MULTIPLIED BY LINE 20)
22  APPORTIONED TAXABLE INCOME (LINE 16 MULTIPLIED BY LINE 20)
23  INCOME APPORTIONMENT FACTOR (IT-140 FILERS DIVIDE LINE 22 BY WEST VIRGINIA ADJUSTED GROSS INCOME. OTHER FILERS 
    MUST CALCULATE AN EQUIVALENT WEST VIRGINIA GROSS INCOME FOLLOWING THE INSTRUCTIONS AT THE END OF THE THIS FORM. 
24  PERSONAL INCOME TAX ATTRIBUTABLE TO QUALIFIED INVESTMENT (WEST VIRGINIA INCOME TAX MULTIPLIED BY LINE 23)
25  MAXIMUM ALLOWABLE PERSONAL INCOME TAX OFFSET (LOWER OF LINE 21 OR LINE 24)
24  PERSONAL INCOME TAX CREDIT CLAIMED
27  TOTAL CREDIT USED THIS TAX YEAR (LINE 19 PLUS LINE 26)
28  REMAINING CREDIT TO BE CARRIED FORWARD ( LINE 13 MINUS LINE 27)

                                      SECTION E: CREDIT CARRYOVER RECAP
RP* YEAR OF CREDIT        ANNUAL CREDIT EARNED                EXCESS CREDIT                    EXCESS CREDIT             REMAINING EXCESS CREDIT
                                                              FROM PRIOR PERIODS               USED THIS YEAR
9
8
7
6
5
4
3
2
1

    LINE 29        ABCD
    TOTAL
* REFERENCE PERIOD (# OF YEARS PRIOR TO CURRENT TAX PERIOD)
                                                                 SIGNATURE
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 (PRINT OR TYPE)                     TITLE DATE

    SIGNATURE OF PREPARPER OTHER THAN TAXPATER                                         ADDRESS                           DATE

                          PERSON TO CONTACT CONCERNING THIS RETURN                                                       TELEPHONE

                                                                   - 2 -

SCHEDULE SAAM-1 (continued) 

                            INVESTMENT LISTING
                            (USE ADDITIONAL SHEETS IF NECESSARY)
NAME OR DESCRIPTION OF ITEM PURPOSE      DATE ACQUIRED/         USEFUL NET COST
(LIST SEPARATELY)                        PLACED IN SERVICE      LIFE

                                    - 3 -

                                                  SAAM-1
     EQUIVALENT WEST VIRGINIA GROSS INCOME INSTRUCTIONS 
A. Calculate equivalent taxable income (ETI).
FOR TAXPAYERS WITH FILING STATUS 1 (SINGLE, HEAD OF HOUSEHOLD, OR WIDOW(ER) WITH DEPENDENT CHILD) OR FILING STATUS 2 (MARRIED FILING JOINTLY). 
IF WEST VIRGINIA INCOME TAX IS                                 THEN ETI IS 
ZERO                                                       ZERO
GREATER THAN ZERO      AND LESS THAN OR EQUAL TO $300,     WEST VIRGINIA INCOME TAX DIVIDED BY 0.0300
GREATER THAN $300      AND LESS THAN OR EQUAL TO $900      $10,000 PLUS THE QUANTITY OBTAINED BY SUBTRACTING $300 
                                                           FROM THE WEST VIRGINIA INCOME TAX AND DIVIDING THIS RESULT BY 0.0400
GREATER THAN $900      AND LESS THAN OR EQUAL TO $1,575    $25,000 PLUS THE QUANTITY OBTAINED BY SUBTRACTING $900 
                                                           FROM THE WEST VIRGINIA INCOME TAX AND DIVIDING THIS RESULT BY 0.0450
GREATER THAN $1,575    AND LESS THAN OR EQUAL TO $2,775    $40,000 PLUS THE QUANTITY OBTAINED BY SUBTRACTING $1,575 
                                                           FROM THE WEST VIRGINIA INCOME TAX AND DIVIDING THIS RESULT BY 0.0600
GREATER THAN $2,775                                        60,000 PLUS THE QUANTITY OBTAINED BY SUBTRACTING $2,775 
                                                           FROM WEST VIRGINIA INCOME TAX AND DIVIDING THIS RESULT BY 0.0650
FOR TAXPAYERS WITH FILING STATUS 3 (MARRIED FILING SEPARATELY) 
IF WEST VIRGINIA INCOME TAX IS                                 THEN ETI IS 
ZERO                                                       ZERO
GREATER THAN ZERO      AND LESS THAN OR EQUAL TO $150,     WEST VIRGINIA INCOME TAX DIVIDED BY 0.0300
GREATER THAN $150      AND LESS THAN OR EQUAL TO $450      $5,000 PLUS THE QUANTITY OBTAINED BY SUBTRACTING $150 
                                                           FROM THE WEST VIRGINIA INCOME TAX AND DIVIDING THIS RESULT BY 0.0400
GREATER THAN $450      AND LESS THAN OR EQUAL TO $787.50   $12,500 PLUS THE QUANTITY OBTAINED BY SUBTRACTING $450 
                                                           FROM THE WEST VIRGINIA INCOME TAX AND DIVIDING THIS RESULT BY 0.0450
GREATER THAN $787.50   AND LESS THAN OR EQUAL TO $1,387.50 $20,000 PLUS THE QUANTITY OBTAINED BY SUBTRACTING $787.50 
                                                           FROM THE WEST VIRGINIA INCOME TAX AND DIVIDING THIS RESULT BY 0.0600
GREATER THAN $1,387.50                                     $30,000 PLUS THE QUANTITY OBTAINED BY SUBTRACTING 1,387.50 
                                                           FROM WEST VIRGINIA INCOME TAX AND DIVIDING THIS RESULT BY 0.0650
B. Calculate equivalent exemption value (EEV).
The equivalent exemption value is determined by multiplying the reported exemption value by the reported income percentage.

C. Equivalent West Virginia Adjusted Gross Income.
The Equivalent West Virginia Adjusted Gross Income is determined as the minimum of Total West Virginia Income (from Form IT-140NR/PY) and the 
sum of the Equivalent Taxable Income (ETI) and the Equivalent Exemption Value (EEV).

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