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F
O                                      CERTIFICATION FOR IDAHO'S 
R89SE
M  EFO00044
   07-28-09              SMALL EMPLOYER TAX INCENTIVES

 Business name                                                                             Federal employer identiication number

 Business mailing address                                                                  Contact person and title

 City, state and zip code                                                                  Telephone number of contact person

QUALIFYING FOR THE INCENTIVES
To claim the Idaho small employer incentives, you must certify that you have met, or will meet, the following tax incentive criteria at the 
project site during the project period:
  1. Capital investment in new plant and building facilities of at least $500,000, 
  2. Increased employment by at least 10 new employees who each earn at least $19.23 per hour worked and receive health  
     beneits, and
  3. For new employment increases above the 10 new employees, the average wages of the additional new employees is at least 
     $15.50 per hour worked.  See the instructions for who is included in this calculation.

The following information is required to certify that the proposed project will meet the small employer tax incentive criteria during the 
project period.  Failure to provide the requested information may result in the Tax Commission denying any tax incentives claimed under 
the Idaho Small Employer Incentive Act.

 1.  Description of qualifying project 

 2.  Estimated/actual start date of project.  The start date is the earlier of the date the irst physical change to the project site  
     occurs or the date new employees related to the project site are irst employed in Idaho.  The start date cannot be earlier than 
     January 1, 2006.

 3.  Estimated/actual end date of project.  The project period cannot be longer than 10 years or end later than December 31, 2020. 

 4.  Location of the project site(s). Identify the street address for each site.  If more than one location, identify the percent of the 
     investment projected at each site once the project is completed.

 5.  Estimated/actual number of new jobs created during the project period.  For each year in the project period, enter the tax 
     year followed by the number of new jobs created during that year.

     Yr_________ # of jobs_________________________                   Yr_________ # of jobs_________________________
     Yr_________ # of jobs_________________________                   Yr_________ # of jobs_________________________
     Yr_________ # of jobs_________________________                   Yr_________ # of jobs_________________________
     Yr_________ # of jobs_________________________                   Yr_________ # of jobs_________________________
     Yr_________ # of jobs_________________________                   Yr_________ # of jobs_________________________

     Total # of jobs ________________________



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EFO00044p2                                                                                                      Form 89SE - Page 2
07-28-09

 6.  Estimated/actual cost of capital investments in new plant and building facilities.  For each year in the project period, list the 
     actual or projected cost of capital investments in new plant and building facilities.

 a.	 Qualiied	investment.		This is property that generally qualiies for the Idaho investment tax credit, including computers,  
     equipment, furniture, etc.  Enter the tax year followed by the cost of qualiied investment placed in service during that year.
     Yr_________ Amount_____________________________               Yr_________ Amount_____________________________
     Yr_________ Amount_____________________________               Yr_________ Amount_____________________________
     Yr_________ Amount_____________________________               Yr_________ Amount_____________________________
     Yr_________ Amount_____________________________               Yr_________ Amount_____________________________
     Yr_________ Amount_____________________________               Yr_________ Amount_____________________________

     Total Amount_____________________________

 b.  Buildings and their structural components, including parking garages.  Enter the tax year followed by the cost of buildings 
     and structural components placed in service during that year.

     Yr_________ Amount_____________________________               Yr_________ Amount_____________________________
     Yr_________ Amount_____________________________               Yr_________ Amount_____________________________
     Yr_________ Amount_____________________________               Yr_________ Amount_____________________________
     Yr_________ Amount_____________________________               Yr_________ Amount_____________________________
     Yr_________ Amount_____________________________               Yr_________ Amount_____________________________

     Total Amount_____________________________

 7.  Total plant and building facilities cost by location

CERTIFICATION BY TAXPAYER

Under penalties of perjury, I declare that to the best of my knowledge and belief this information is true, correct and complete.
Signature of oficer                                                                       Date

Title                                                                                     Phone number of oficer

Mail to:  TAX POLICY
          IDAHO STATE TAX COMMISSION
          PO BOX 36
          BOISE ID 83722

or

Fax to:  TAX POLICY
          (208) 334-7844



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EFO00044p3
07-28-09
                          Instructions for Idaho Form 89SE

            GENERAL INSTRUCTIONS                                        New Employees
                                                                        To qualify as a new employee for the tax incentive criteria, an 
You must ile Form 89SE prior to claiming any incentives allowed         employee must:
by the Idaho Small Employer Incentive Act.  A copy of Form 
89SE must be attached to your Idaho income tax return for each          ● Be employed primarily at the project site by the taxpayer, 
tax year in which you are claiming or carrying over the incentives.     ● Have wages subject to Idaho income tax withholding,
                                                                        ● Be covered for Idaho unemployment insurance purposes,
TAX INCENTIVE CRITERIA                                                  ● Be eligible to receive employer provided coverage under a 
                                                                          health plan described in Idaho Code section 41-4703,
To qualify you must certify that you have met, or will meet, the        ● Be employed on a regular full-time basis, and 
following tax incentive criteria at the project site during the project ● Meet the applicable wage requirements. 
period:
                                                                        For this purpose, earnings include income subject to Idaho 
● Invest at least $500,000 in new plant and building facilities,        income tax withholding, but do not include stock options or 
● Increase employment at the project site by at least 10 new            restricted stock grants.
  employees, who each earn at least $19.23 per hour, and 
● If your new employment increased by more than the 10 new              An existing employee of the taxpayer or a related taxpayer who 
  employees, these additional new employees must on average             is transferred to a new position at the project site will not qualify 
  earn at least $15.50 per hour worked during your tax year.            as a new employee, unless the transfer results in a net new job 
  Do not include the wages of employees earning more than               in Idaho.
  $48.08 per hour.
                                                                        Once reached, the net increase in employment at the project site 
Project Site                                                            must be maintained for the rest of the project period.  
Project site is where new plant and building facilities owned or 
leased by the taxpayer are located.  The project site can be one        TAX INCENTIVES  
or more geographic areas in Idaho, but only if 80% or more of 
the investment required is located at one of the areas.                 If you have met, or will meet the tax incentive criteria, you are 
                                                                        eligible to claim the tax incentives listed in the table on page 2.
Project Period
Project period is the period of time that begins at the earlier of:     RECAPTURE 
● A physical change to the project site, or                             If you certify you will meet the tax incentive criteria, and then fail 
● The irst employment of new employees in Idaho who are                 to meet the tax incentive criteria, you will be required to recapture 
  related to the activities at the project site.                        the full amount of any incentives claimed under the Act.
The project period cannot begin before January 1, 2006.                 Recapture of all or a portion of the incentives may also be 
                                                                        necessary if you: 
The project period ends when the facilities constituting the 
project are placed in service, but no longer than 10 years or later     ● Dispose of an investment in new plant or building facilities or 
than December 31, 2020.                                                   it ceases to qualify prior to it being held for ive years from the 
                                                                          date placed in service,
New Plant and Building Facilities                                       ● Do not maintain the required level of employment for ive 
New plant and building facilities include property that meets             years from the date the project period ends, or 
either the deinition of qualiied investment for purposes of             ● Do not use, store, or otherwise consume property that was 
the investment tax credit (ITC) or is a building or a structural          allowed a sales tax exemption within the project site for a 
component of a building.                                                  period of ive full years from the date the property was placed 
                                                                          in service.
The property must be new property.  Used property does not 
qualify.  New property is property acquired or constructed by the 
taxpayer whose original use begins with the taxpayer after such 
acquisition or construction.  Original use means the irst use to 
which the property is put, whether or not that corresponds to 
the use of the property by the taxpayer.  Property used by the 
taxpayer prior to its acquisition does not qualify.  



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EFO00044p4
07-28-09                                                                                                          Form 89SE - Page 2

                      SMALL EMPLOYER INCENTIVE ACT — Idaho Code, Title 63, Chapter 44
        Incentive                           Credit Rate                                           Limitations     Carryover
Investment Tax Credit 3.75% on qualiied investment that is placed in service          Cannot exceed 62.5% of      14 years
(SE-ITC)              during the project period anywhere in Idaho. Credit is in lieu  tax. Cannot exceed  
Form 83               of earning the 3% ITC.                                          $750,000 in any tax year
Real Property         2.5% on investments in new plant and buildings and              Cannot exceed $125,000 in   14 years
Improvement Tax       structural components of buildings that do not qualify for the  any tax year
Credit (SE-RPITC)     ITC and are placed in service during the project period at 
Form 84               the project site
New Jobs Tax Credit   Varying credit rate from $1,500 to $3,000 per qualifying new    Cannot exceed 62.5%         10 years
(SE-NJTC)             employee. Employee must earn a minimum of $24.04 per            of tax
Form 85               hour to qualify, be employed primarily within the project site 
                      on a full-time basis, and work a minimum of nine months 
                      during the tax year. (See other requirements under New 
                      Employees.)
Sales Tax Rebate      25% rebate of all sales and use taxes that the taxpayer 
                      or its contractors actually paid in regard to new plant and 
                      building facilities property constructed, located or installed 
                      within the project site during the project period
Growth Incentive      County Board of Equalization of county in which property 
Exemption             that qualiies for the ITC or RPITC is located can exempt all 
                      or part of the value of the property from property tax.

          SPECIFIC INSTRUCTIONS                                       invested in the project that will be located at each separate 
                                                                      location.  The total of these percents must equal 100%.
Instructions are for lines not fully explained on the form.  
                                                                      Line 5.  For each year in the project period, enter the actual or 
HEADING                                                               estimated number of new jobs that have been, or will be, created 
Write your business name, address, federal employer                   within the project site.  If a year listed on the form does not fall 
identiication number, contact person and title, and the contact       within the project period, leave it blank.  
person’s telephone number in the space at the top of the form.  
                                                                      Line 6.  For each year in the project period, enter the actual or 
Line 1.  Provide a detailed description of the project that qualiies  estimated costs of capital investment in new plant and building 
for the incentives.  Attach additional sheets as necessary.           facilities located within the project site.  If a year listed on the 
                                                                      form does not fall within the project period, leave it blank.  
Line 2.  Enter the date the project started or will start.  The start 
date cannot be earlier than January 1, 2006.  The start date is       List the cost of property that qualiies for the ITC in 6a.  List the 
the earlier of the date the irst physical change to the project site  cost of buildings and their structural components that do not 
is scheduled to occur or the date new employees related to the        qualify for the ITC in 6b.  
project site will be irst employed in Idaho.
                                                                      Line 7.  For each location in your project site, identify the total 
Line 3.  Enter the date the project ended or is scheduled to end.     actual or projected cost of new plant and building facilities.  The 
This date cannot be longer than 10 years or later than December       total of these amounts should match the sum of the totals for 
31, 2020.                                                             lines 6a and 6b.

Line 4.  For each project site, provide the street address.  
Include the percent of the new plant and building facilities 





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