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Local Incentive Bonus Information
ONLY HIGH IMPACT PROJECTS ELIGIBLE FOR LOCAL INCENTIVE BONUS COMPLETE THIS SECTION . IF DOCUMENTATION OF LOCAL INCENTIVES HAS
NOT BEEN PROVIDED FOR THIS PROGRAM , ATTACH A COPY TO THIS APPLICATION.
HOW MANY YEARS ARE LOCAL INCENTIVES TO BE PROVIDED TO THIS PROJECT?
AN AFFIDAVIT FOR THE LOCAL GOVERNMENT TO VERIFY THE AMOUNT OF LOCAL INCENTIVES PROVIDED TO THE PROJECT IS ATTACHED . THIS
VERIFICATION IS REQUIRED BEFORE BONUS PERCENTAGES WILL BE APPLIED TO THE TAX CREDIT CALCULATION.
CERTIFICATION Please Read Carefully & Thoroughly
• 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 understand that, pursuant to section 285.530.5, RSMo, a general contractor or subcontractor of any tier shall not be liable under
sections 285.525 to 285.550 when such general contractor or subcontractor contracts with its direct subcontractor who violates
section 285.530.1, if the contract binding the contractor and subcontractor affirmatively states that the direct subcontractor is not
knowingly in violation of section 285.530.1 and shall not henceforth be in such violation and the contractor or subcontractor
receives a sworn affidavit under the penalty of perjury attesting to the fact that the direct subcontractor’s employees are lawfully
present in the United States.
• 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 Missouri Quality Jobs 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.
Applicant Signature Title
Print Name Date
Notary Public Embosser Seal Appeared before me this _________ day of _______________, 20____,
____________________________ to me personally known to be the person who executed the above
certification, and acknowledged and states on his/her oath to me that he/she executed the same for the
purpose therein stated.
State of County (or City of St. Louis)
Notary Public Name My Commission Use Rubber Stamp in Area Below
Expires
Notary Public Signature
Effective August 28, 2005, and pursuant to Section 620.1900, RSMo, this tax credit program is subject to a fee of 2.5% of the
amount of tax credits issued. Applicants will be invoiced for the fee after the tax credit application has been approved. Tax
credits will be issued upon receipt of the fee.
March 2009
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