Fillable Printable Form 50469
Fillable Printable Form 50469
Form 50469
ENTERPRISE ZONE BUSINESS REGISTRATION (EZB-R) –
FOR CALENDAR YEAR 2015
State Form 50469 (R13 / 10-15)
Approved by State Board of Accounts, 2016
INDIANA ECONOMIC DEVELOPMENT CORPORATION (IEDC)
PART I - GENERAL INFORMATION
1. Name of business
5. Social Security number or Federal Identification number
2. Telephone number
( )
INSTRUCTIONS (Please see page 2 for detailed, line-by-line instructions.):
1. Please print legibly or type. Please complete each section entirely.
2. A zone business that accesses at least one (1) tax credit or exemption shall submit to the IEDC this verified summary of the amount of the tax credits and
exemptions claimed by the business in 2015 postmarked no later than June 1, 2016. If a zone business cannot comply with this date, it must apply for an
extension to the IEDC utilizing the approved EZB-E form postmarked no later than June 1, 2016. If an extension is approved, this EZB-R registration form
and fees must be submitted postmarked no later than July 15, 2016.
DISTRIBUTION:Original – IEDC; Copy – Send to local UEA; Copy – Keep for your records
The information on this form is confidential
according to IC 5-28-15-8.
3. Mailing address (number and street, city, state, and ZIP code)
4. Zone address (number and street, city, state, and ZIP code)
6. Legal business form (check one)
“C” Corporation “S” Corporation Partnership Sole Proprietorship
8. Average Level of Employment at the Zone Location During Calendar Year 2015
9. Average Level of Employment of Zone Residents at the Zone Location During Calendar Year 2015
10. Total Wages and Salaries at the Zone Location During Calendar Year 2015
11. Total Wages and Salaries of Your Zone Resident Employees During Calendar Year 2015
12. Number of Enterprise Zone Qualified Employee Certificates (IT-40QEC) Issued for the Calendar Year
13. Total New Jobs Created at the Zone Location During Calendar Year 2015
14. Total New Jobs Filled by Zone Residents During Calendar Year 2015
Address of preparer (number and street, city, state, and ZIP code)
Printed name of preparerTelephone number of preparer
( )
Signature of preparerDate (month, day, year)
Printed name of corporate / firm officer
Signature of corporate / firm officerDate (month, day, year)
Title of corporate / firm officer
Under penalties of perjury, I declare that I have examined this form, including accompanying schedules, and to the best of my knowledge and belief, it is
true, correct, and complete.
PART II - TAX SAVINGS SUMMARY
15. Total Enterprise Zone Investment Deduction
A. Total Tax Savings from Enterprise Zone Investment Deduction
16. Total Employment Expense Credit (from Part II, Schedule EZ)
17. Total Loan Interest Credit (from Schedule LIC, Attach Copy)
18. Total Tax Savings (sum of Lines 15A through 17)
PART III - REGISTRATION FEE AND ELIGIBILITY
19. Registration fee
If the total on Line 18, Part II, exceeds $1,000, multiply the total on Line 18 by .01 and remit the registration fee with the original EZB-R form to:
Indiana Economic Development Corporation, Indiana Enterprise Zone Program, One North Capitol, Suite 700, Indianapolis, IN 46204-2288.
In 2009, a zone business is required by law to use all its tax-saving incentives, except for the registration fee, for its property or employees in the zone.
In addition to the registration fee paid under (a)(4) of IC 5-28-15-5, each zone business that receives a credit under this chapter shall assist the urban
enterprise association in an amount determined by the legislative body of the municipality in which the zone is located. If a zone business does not
assist an urban enterprise association, the legislative body of the municipality in which the zone is located may pass an ordinance disqualifying a zone
business from eligibility for all credits or incentives available to zone businesses.
20. Financial Compliance to the local Urban Enterprise Association
21. New Capital Investment in Enterprise Zone for the 2015 Calendar Year:
A. Building Renovation or Improvements
B. New Equipment
22. Total Increased Zone Resident Employee Wages and Salaries or Other Compensation for 2015 Calendar Year
23. Total (Sum of Lines 19, 20, 21A, 21B, and 22)
The sum of all lines in Part III must equal or exceed the amount in Part II, Line 18 to avoid disqualification from eligibility of enterprise zone incentives.
First time filing
Yes No
7. E-mail address
Reset Form
0.00
0.00
INSTRUCTIONS FOR COMPLETING THE EZB-R
Part of State Form 50469 (R13 / 10-15)
Part I General Information
Line 1: Enter legal name of the business.
Line 2: Enter the business telephone and fax number (including area code).
Line 3: Enter the mailing address of the business.
Line 4: Enter the address of the business location in the enterprise zone or inventory location.
Line 5: Enter the Social Security number or the federal identification number of the business.
Line 6: Check the appropriate organizational form of the business.
Line 7: Enter e-mail address.
Line 8: List the total number of employees at the zone location on the 15th day of each month, add the column, divide by 12 and enter the number on line 8.
Example for line 8:
Date Employees
January 15 30
February 15 30
March 15 30
April 15 30
May 15 30
June 15 45
July 15 45
August 15 45
September 15 25
October 15 25
November 15 30
December 15 30
Year Total 395
395 ÷ 12 = 32.9 Enter 32.9 on line 8
Line 9: List the total number of zone residents employed at the zone location on the 15th day of each month, divide the resulting figure by 12 and enter the
number on line 9 (see example in line 8 instructions). Every participating business must complete this line, even if your business does not
utilize the hiring tax credits.
Line 10: Enter the total of all wages and salaries paid at the zone location for the calendar year for which you are filing.
Line 11: Enter the total wages and salaries paid to zone resident employees at the zone location for the calendar year for which you are filing.
Line 12: Enter the total number of Enterprise Zone Qualified Employee Certificates (IT-40QEC) issued for the calendar year for which you are filing.
Line 13: Enter the total number of new jobs created at the zone location during the calendar year for which you are filing.
Line 14 Enter the total number of new jobs filled by zone residents during the calendar year for which you are filing.
Part II Tax Savings Summary
If you are a new business or have no tax savings to report for the calendar year for which this form applies, please skip to Part III of this form.
Line 15: Enter the total Enterprise Zone Investment Deduction.
A. Enter the total Tax Savings from Enterprise Zone Investment Deduction.
Line 16: Enter the employment expense credit amount from Schedule EZ.
Line 17: Enter the loan interest credit amount from Schedule LIC.
Line 18: Add the amounts in Lines 15A-17 and enter amount.
Part III Registration Fee and Eligibility
Line 19: If the total on line 18, Part II exceeds $1,000, multiply the amount by .01 and enter that amount on this line. If a zone business receives tax-saving
incentives in excess of $1,000 in any year, the business MUST pay an annual registration fee of one percent (1%) of its tax savings to the INDIANA
ECONOMIC DEVELOPMENT CORPORATION, or be denied credits and incentives, and disqualified from further participation according to
IC 5-28-15-7. REMIT THE AMOUNT ON THIS LINE WITH THE ORIGINAL EZB-R TO: INDIANA ECONOMIC DEVELOPMENT CORPORATION,
One North Capitol, Suite 700, Indianapolis, IN 46204-2288.
You must still submit an EZB-R even if your business does not owe a registration fee!
Line 20: Multiply the amount on line 18, Part II of this form by the local UEA rate and enter that amount on this line (please contact the local UEA to determine
the rate). REMIT THE AMOUNT ON THIS LINE TO THE LOCAL UEA WITH A COPY OF THIS EZB-R.
Line 21: New Capital Investment for the Calendar Year
A. Enter the total dollar amount spent in the calendar year for zone business renovation and improvements at the zone location.
B. Enter the total dollar amount spent in the calendar year for new equipment at the zone location.
Line 22: Enter the amount of zone resident employee wages for the calendar year that exceeds each taxpayer’s base period qualified wages AND/OR the
total dollar amount spent on employee training.
Line 23: Add lines 19, 20, 21A, 21B, and 22 enter that amount on this line.
Signature Lines
Corporate/firm officer must sign this form and print name below written signature. Failure to sign and print name and title may delay processing and may
result in your form being returned to you. If someone other than the corporate/firm officer prepared this form, their name, signature, address and telephone
number are required.
GENERAL EZB-R QUESTIONS
Part of State Form 50469 (R13 / 10-15)
Who should file the EZB-R?:Any zone business or entity that claims any of the incentives available to zone businesses must submit to the
Indiana Economic Development Corporation (IEDC) a verified summary of the amount of tax credits and exemptions claimed by the business
in the preceding year. Failure to file an EZB-R while claiming an exemption or credit will result in denial of the tax credits and exemptions
available and disqualification from further participation in the enterprise zone program.
When should the EZB-R be filed?:Any entity that accesses one or more Enterprise Zone tax incentives is required to file a registration form
with the IEDC postmarked no later than June 1 of each year. This means that forms must be postmarked by the post office, not
meter-dated or faxed.
What if a business cannot meet the June 1 filing deadline?: If the June 1 date cannot be met, the extension form should be filed to
provide additional time to complete the registration form. The registration extension form (EZB-E) is due postmarked no later than June 1.
The IEDC may approve an extension time of up to 45 days. (If approved, the EZB-E will be returned with “APPROVED” stamped on it.
Please attach an approved EZB-E to the EZB-R.)
What if I miss the June 1 deadline to file an extension?: If a business misses the June 1 deadline to file an extension, the business has
forty-five (45) days to submit the EZB-R form AND pay a 15% penalty to the IEDC. The 15% penalty is based on the total tax savings of
the business for the tax year.
What if I do not know what my tax savings is by June 1st or July 15th?: If the business does not know their tax savings by June 1, they
should file an extension (EZB-E) by June 1, which will enable them to file the EZB-R form by July 15. If the business still will not know the tax
savings by July 15, an EZB-R form is still due by July 15; however, the form will be incomplete. As soon as the tax savings amount is known,
the business must submit a complete EZB-R form (and if applicable) send a check for 1 percent of the tax savings to the IEDC.
What if a business has several locations?:A separate form is required for each zone business or entity claiming an exemption or credit.
If the business has more than one location or subsidiary, a separate registration form must be filed for each business location.
Who should receive the EZB-R form?: The revised EZB-R is a single form with instructions on the reverse side.
The original form (with the original signatures) must be sent to the IEDC. The original form should be accompanied with a
registration fee (if tax savings are greater than $1,000). The registration fee is equaled to a zone business’ total tax savings
multiplied by 0.01. In addition, a copy must be mailed to the local Urban Enterprise Association along with the contribution check in
accordance with the rate set by the city council of a particular zone. This contribution is separate from an in addition to the registration fee
that is sent to the IEDC. Please contact your local UEA to obtain information about its contribution rate. Finally, the participating business
should keep one copy of the EZB-R for their records.
Please note the following:
Any information omissions on the registration form may delay processing.
A corporate or firm officer must sign the registration form.
The registration fee must accompany the registration form.
If the EZB-R is returned for completion, omission of check, or correction, the business has forty-five (45) days in which to return the
corrected EZB-R.
