Arizona Form  
                                                        Credit for New Employment                                                                                       2021
               345
Include with your return.
 For the calendar year 2021 or fiscal year beginning    M M D D                    2 0 2 1  and ending                                                   M M D D Y      Y   Y      Y .
 Name as shown on Form 140, 140PY, 140NR, 140X, 140-SBI, 140PY-SBI, 140NR-SBI, 140X-SBI,                                                             Social Security or 
 99T, 120, 120A, 120S, 120X, or 165                                                                                                                  Employer Identification Number

 Part 1  Business Information
  1 Business Name

  2 Business Location Address — Street

    City                                          State ZIP Code

  3 Employer Identification Number

 4a  What type of entity is the business?
     C Corporation  Exempt Organization          Limited Liability Company (LLC) 
     Partnership    S Corporation                Sole Proprietorship
 4b  If the business is an LLC, what is the federal tax classification?  Check only one box:
     C Corporation  Disregarded Entity           Partnership                  S Corporation
    If the business is an LLC, a partnership or an S Corporation, include a schedule that lists ownership information including: name, address, TIN,  
    and ownership percentage at the end of the tax year.

 Part 2  Qualification for Credit
  5 Did you receive certification from the Arizona Commerce Authority? ..........................................                               Yes  No 
    If “Yes”, include a copy of the Certification.
  6 Are you claiming a pass through of this credit from a partnership and/or an S Corporation? .....                                            Yes  No 
    If “Yes”, include a copy of Form(s) 345-P and/or Form(s) 345-S.
  7 If you answered “Yes” to the question on line 5 or on line 6, go to Part 3. 
    If you answered “No” to the questions on line 5 and on line 6, STOP! 
    YOU ARE NOT ELIGIBLE TO CLAIM THIS CREDIT.

 Part 3  Current Taxable Year’s Credit Calculation
                                                                                                                                                     (a)                (b) 
                                                                                                                                                  Number of Available Credit:
                                                                                                                                                  Employees
                                                                                                                                                            Multiply column (a) by $3,000.
 8  Credit for employees in first year or partial year of employment in a qualified employment 
    position ................................................................................................................................. 8                                   00
 9  Credit for employees in the second year of continuous employment in a qualified 
    employment position.............................................................................................................           9                                   00
10  Credit for employees in the third year of continuous employment in a qualified 
    employment position.............................................................................................................           10                                  00

 11 Enter the credit passed through from partnerships on Form(s) 345-P, line 3c  ....................                                          11                                  00

12  Enter the credit passed through from S Corporations on Form(s) 345-S, line 3c.................                                             12                                  00
13  Add lines 8 through 12 in column (b).  Enter the total.  This is your total current year’s 
    credit for New Employment. .................................................................................................               13                                  00

                                                                                                                                                            Continued on page 2 
ADOR 11149 (21)

 Name (as shown on page 1)                                                         TIN

 Part 4     Partnerships

A partnership claiming this credit must pass the credit through to its partners.
    •  Complete Form 345-P for each partner.
    •  Provide a completed copy of Form 345-P to each partner.
    •  Include a copy of each completed Form 345-P with your tax return.
    •  Keep a copy of each completed Form 345-P for your records.
    •  Do not complete Parts 5 through 7 of this form.

 Part 5     S Corporation Credit Election and Shareholder’s Share of Credit
 14 The S Corporation has made an irrevocable election for the taxable year ending M M D D Y Y Y Y  to 
    (check only one box):
    14a  Claim the credit for new employment as shown on Part 3, line 13 (for the taxable year indicated above);
             OR
    14b     Pass the credit for new employment as shown on Part 3, line 13 (for the taxable year indicated above) through to its shareholders.

    Signature                                                     Title                                                                                                             Date

If passing the credit through to the shareholders, complete Form 345-S for each shareholder.
    •  Provide a copy of completed Form 345-S to each shareholder.
    •  Include a copy of each completed Form 345-S with your tax return.
    •  Keep a copy of each completed Form 345-S for your records.

 Part 6     Available Credit Carryover
                                     (a)                      (b)                  (c)             (d)                                                                                  (e)

 15   Taxable year ...............

 16   Original credit amount                00                          00                  00                                                                                   00            00

 17   Amount 
      previously used...........            00                          00                  00                                                                                   00            00
 18   Tentative carryover: 
      Subtract line 17 
      from line 16 .................        00                          00                  00                                                                                   00            00

 19   Amount disallowed: 
      See instructions ..........           00                          00                  00                                                                                   00            00
 20   Available carryover: 
      Subtract line 19 
      from line 18 .................        00                          00                  00                                                                                   00            00

 21   Total Available Carryover ................................................................................................................................................ 21            00

                                                                                                                                                                                    Continued on page 3 

 ADOR 11149 (21)                                              AZ Form 345 (2021)                                                                                                        Page 2 of 3

 Name (as shown on page 1)                                            TIN

 Part 7    Total Available Credit
 22 Current year’s credit for new employment:
    • Individuals, C Corporations, S Corporations claiming this credit at the corporate level, or exempt organizations  
      with UBTI:  Enter the amount from Part 3, line 13, column (b).
    • Individuals that did not make the Small Business Income election:  Also, enter this amount on Form 301,  
      Part 1, line 21, column (a).
    • Individuals that made the Small Business Income election:  Also, enter this information on Form 301-SBI, 
      Part 1, line 16, column (a).
    • C Corporations, S Corporations claiming this credit at the corporate level, and exempt organizations with UBTI: 
      Also, enter this amount on Form 300, Part 1, line 14, column (a).. .............................................................................      22            00
 23 Available credit carryover from Part 6, line 21, column (e):
    • Individuals that did not make the Small Business Income election: Also, enter this amount on Form 301,  
      Part 1, line 21, column (b).
    •  Individuals that made the Small Business Income election:  Also, enter this amount on Form 301-SBI, Part 1  
      line 16, column (b) 
    • C Corporations, S Corporations claiming this credit at the corporate level, and exempt organizations with UBTI:  
      Also, enter this credit on Form 300, Part 1, line 14, column (b). .................................................................................   23            00
 24 Total available credit:  Add lines 22 and 23 and enter the total.
    • Individuals that did not make the Small Business Income election:  Also, enter total here and on Form 301,  
      Part 1, line 21, column (c).
    • Individuals that made the Small Business Income election:  Also, enter this information on Form 301-SBI, 
      Part 1, line 16, column (c).
    • C Corporations, S Corporations claiming this credit at the corporate level, and exempt organizations with UBTI: 
      Also, enter this credit on Form 300, Part 1, line 14, column (c). ..................................................................................  24            00

ADOR 11149 (21)                              AZ Form 345 (2021)                                     Print 345                                                  Page 3 of 3

 Name (as shown on Form 345)                                                            TIN
                                                                                                                                                                              Page     of 
    Form 345-1                   Employees at Business Location                                                                                                                      2021
Complete a Form 345-1 for each employee, whether or not the employee is in a qualified employment position.  See instructions
 1  Employee name:  

 2  Employee’s Social Security Number (SSN) .............................................................................................................. 

 3a  What credit year are you claiming for this employee?   First       Second       Third       Not qualified for credit, or fourth year or more

 3b  Is this employee a replacement of another employee who left a qualified employment position in the second or 
    third year?  See instructions ........................................................................................................................................   Yes     No

 3c  If the answer to line 3b is “Yes”, did the total time the position was vacant from the date the employment position 
    was originally filled to the end of the current tax year total 90 days or less?  See instructions .......................................                                Yes     No

 3d  If the answer to line 3c is “Yes”, enter the name of the replaced employee, his or her Social Security Number, and termination date:
    Employee Name                                                                       Social Security Number                                                              Termination Date
                                                                                                                                                                            M M D D Y Y Y Y

 4a  Current date of employment .....................................................................................................................................       M M D D Y Y Y Y

 4b  Termination date, if the employee was terminated before the end of the taxable year ............................................                                       M M D D Y Y Y Y

 4c  If the employee was terminated, is he or she replaced by a new hire in the same qualified employment position?                                                          Yes     No 
    If the answer is “Yes”, enter the name of the new hire, his or her Social Security Number, and hire date:
    Employee Name                                                                       Social Security Number                                                              Hire Date
                                                                                                                                                                            M M D D Y Y Y Y

 5a  If employee was previously employed by the business, list the previous date of employment.  See instructions. ......                                                   M M D D Y Y Y Y

 5b  If employee was previously employed by the business, list the date of separation..................................................                                     M M D D Y Y Y Y

 5c  Did the employee relocate to this state from out of state? .......................................................................................                      Yes     No

 5d  If the employee relocated from out of state, enter date of relocation .......................................................................                          M M D D Y Y Y Y

 6a  Is the employee in a permanent position that consists of at least 1750 hours per year? .........................................                                        Yes     No

 6b  If the answer to line 6a is “Yes”, list the number of hours the employee actually worked during the taxable year. ......  

 7  Are the employee’s job duties performed primarily at the location(s) of the business? ............................................                                       Yes     No

 8a  Employee’s annual compensation for the taxable year ............................................................................................                       $               . 00

 8b  Employee’s HOURLY wage in dollars and cents .....................................................................................................                      $               .

 9a  Total cost of health insurance provided by employer for employee.  See instructions. ...............................................                                   $               . 00

 9b  Total cost of health insurance for employee paid by employer.  See instructions........................................................                                $               . 00

 10 Is this employee in a new qualified employment position? .......................................................................................                         Yes     No

 11a  Has this employee been substituted for another employee in a qualified employment position? ............................                                               Yes     No

 11b  If answer on line 11a is “Yes”, list the date of substitution M M D D Y Y Y Y  and indicate whether the individual is a second year 
    employee or a third year employee. See instructions for the qualification before answering this question. 
    Check only one box:   Second year employee       Third year employee

ADOR 11149 (21)                                                          Print 345-1

Name (as shown on Form 345)                                                                                                       TIN
                                                                                                                                                                  Page       of 
   Form 345-2                   Employees in Qualified Employment Positions                                                                                                 2021
                            (a)             (b)                                                                                                 (c)                         (d)
                Employee’s Name             Social Security                                                                                   Type of Employee       Limitation on Total 
                                            Number                                                                                                                   Number of Credits
                                                                                                                                     Check the appropriate box. 
                                                                                                                                     This employee is a:
                                                                                                                                     (c1)     (c2)              (c3) See instructions 
                                                                                                                                     1 stYear 2 ndYear  3  Yearrd    before checking 
                                                                                                                                     Employee Employee Employee      this box.

1

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4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23
24 TOTAL:  Add lines 1 through 23 including only lines with check marks. Enter the total 
   for each column .............................................................................................................. 24
If you are claiming more than 23 employees in qualified employment positions, complete additional schedules.
ADOR 11149 (21)                 Print 345-2 Clear 345-2