State of Rhode Island Division of Taxation 
     Form RI-2949 
     Jobs Training Tax Credit                                                                                     15131299990101

Name                                                                                                           Federal employer identification number For the year ending:

HUMAN RESOURCE INVESTMENT COUNCIL CERTIFICATE NUMBER: 
ATTACH COPY OF NOTICE OF CERTIFICATION ISSUED BY HRIC 

    Qualifying                    Social          Hourly       Average  Eligible Wages (Not                       * Individual                        TOTAL 
    Employee Name           Security Number        Rate     Hrs Weekly  to Exceed $1,000)                         Expenses (3 yrs)                    EXPENSES 

    TOTALS: 
(attach sheet if necessary) 

1.  Payments for instructors or educational institutions..................................                     1. 
2.  Other expenses. Attach schedule............................................................. 2.               
3.  Eligible wages from schedule above......................................................... 3.                
4.  Total Expenses. Add lines 1, 2 and 3..................................................................................................... 4. 
5.  Applicable grants received........................................................................         5. 
6.  Amount of training expenses over $10,000 for an individual employee                                        6. 
    during three year period.................................................................................. 
7.  Total Ineligible Expenses. Add lines 5 and 6..........................................................................................    7. 
8.  Qualifying Expenses. Subtract line 7 from line 4 ..................................................................................       8. 
9.  Credit Calculation. Multiply line 8 times 50% (0.50)...............................................................................       9. 
10. Credit for this taxable year. Multiply line 9 times 50% (0.50).................................................................           10. 
11. Credit carryover from prior year. Attach schedule.................................................................................. 11.       
12. Total Job Training Credit Available. Add lines 10 and 11........................................................................ 12.         
13. Carryover to following taxable year. Multiply line 9 times 50% (0.50).................................................... 13.                

* EXPENSES NOT TO EXCEED $10,000 FOR EACH INDIVIDUAL IN ANY THREE (3) YEAR PERIOD.

THIS FORM MUST BE ATTACHED TO APPROPRIATE RHODE ISLAND TAX RETURN. 
DO NOT SUBMIT COMPLETED FORM WITH HRIC APPLICATION FOR CERTIFICATION. 

                                                        R.I. Gen. Laws § 42-64.6