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CERTIFICATION
I certify that I am an authorized representative of the applicant and as such am authorized to make the statement of affirmation
contained herein.
I certify that the applicant does NOT knowingly employ any person who is an unauthorized alien and that the applicant has complied
with federal law (8 U.S.C. § 1324a) requiring the examination of an appropriate document or documents to verify that each individual
is not an unauthorized alien.
I certify that the applicant is enrolled and will participate in a federal work authorization program as defined in Section 285.525(6),
RSMo., with respect to employees working in connection with the activities that qualify applicant for this program. I certify that the
applicant will maintain and, upon request, provide the Department of Economic Development documentation demonstrating
applicant’s participation in a federal work authorization program with respect to employees working in connection with the activities
that qualify applicant for this program.
I certify that the applicant shall include in any contract it enters with a subcontractor in connection with the activities that qualify
applicant for this program, an affirmative statement from the subcontractor that such subcontractor is not knowingly in violation of
Section 285.530.1, RSMo., and shall not be in violation during the length of the contract. In addition the applicant will receive a
sworn affidavit from the subcontractor under the penalty of perjury, attesting that the subcontractor’s employees are lawfully present
in the United States. I certify that the applicant will maintain and provide the Department of Economic Development access to
documentation demonstrating compliance with this requirement.
I understand that if the applicant is found to have employed an unauthorized alien, applicant maybe subject to penalties pursuant to
Sections 135.815, 285.025, and 285.535, RSMo.
I understand that if the applicant is found to have employed an unauthorized alien in Missouri and did not, for that employee,
examine the document(s) required by federal law, the applicant shall be ineligible for any state-administered or subsidized tax credit,
tax abatement or loan for a period of five years following any such finding.
I attest that I have read and understand the Enterprise Zone Tax Credit Program guidelines.
I hereby agree to allow representatives of the Department of Economic Development access to the property and applicable records
as may be necessary for the administration of this program.
I certify under penalties of perjury that the above statements and information contained in the application and attachments are
complete, true, and correct to the best of my knowledge and belief.
CERTIFICATION
Required Attachment:
Copy of the executed Memorandum of Understanding between the company/organization and the Department of Homeland Security,
United States Citizenship and Immigration Services (DHS-USCIS) and Social Security Administration.
MUST BE SIGNED IN PRESENCE OF NOTARY:
SIGNATURE OF TAXPAYER OR AUTHORIZED REPRESENTATIVE
STATE OF MISSOURI )
) ss.
COUNTY/CITY OF ________________________ )
On this ________ day of _________________________, 200___, before me, _____________________________________________, a
Notary Public in and for said state, personally appeared ____________________________________, known to me to be the person who
executed the Certification and acknowledged and states on his/her oath to me that he/she executed the same for the purposes therein
stated.
Notary Public
My commission expires
MAIL ALL CLAIMS FOR TAX BENEFITS AND ALL RELATED INQUIRIES TO: FINANCE MANAGEMENT, MISSOURI DEPARTMENT OF
ECONOMIC DEVELOPMENT, PO BOX 118, JEFFERSON CITY, MO 65102
SCHEDULES S AND M MUST ACCOMPANY THIS APPLICATION
THIS APPLICATION MUST BE FILED WITH THE DEPARTMENT OF ECONOMIC DEVELOPMENT FOR CREDIT CERTIFICATION PRIOR TO
CLAIMING THE BENEFITS ON YOUR MISSOURI TAX RETURN.
Last Updated March 2009
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