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Arizona Form
Credit for Qualified Facilities 2022
349
Include this completed form and the Certification of Qualification from the Arizona Commerce Authority with your return.

For the calendar year 2022 or fiscal year beginning M M D D 2 0 2 2 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 Listing of Post-Approved Qualified Facilities and Apportioned Credit Amount
List qualified facilities for which you are entitled to claim a credit during this taxable year. If you have more than two facilities, include
additional schedules. See instructions.
(a) (b)
Arizona Commerce Authority Post-Approval Information Apportioned Credit
(a)1 (a)2 (a)3 Amount
Allocation Year First Installment Tax Year Ending Post-Approval Number

1 Y Y Y Y M M D D Y Y Y Y 00

2 Y Y Y Y M M D D Y Y Y Y 00

3 Enter the total from all additional schedules ..................................................... 3 00
4 Enter the total amount of this credit passed through from partnerships on
Form 349-P, Part 1, line 3c ............................................................................... 4 00
5 Enter the total amount of this credit passed through from S Corporations on
Form 349-S, Part 1, line 3c............................................................................... 5 00
6 Subtotal: Add lines 1 through 5, column (b). Enter the total. This is your total
apportioned credit amount ................................................................................ 6 00

Part 2 Full-Time Employment Positions Vacant More Than 150 Days
List the number of full-time employment positions which were vacant for more than 150 days since the credit was approved. If positions
were vacant at more than two facilities, include additional schedules. See instructions.
(a) (b) (c) (d) (e)
Allocation Year Post-Approval Number Number of Employees Reduction Total

7 Y Y Y Y $4,000.00 00

8 Y Y Y Y $4,000.00 00
9 Total from all additional schedules............................................................................................................. 9 00

10 Subtotal: Add lines 7 through 9, column (e). Enter the total. This is the amount of your credit reduction. 10 00

Part 3 Net Credit
11 Subtract the amount on line 10 from the amount on line 6. Enter the difference. If less than
zero, enter “0” ............................................................................................................................................ 11 00

Part 4 Credit Recapture
12 Date on which the certification of the business as a qualified facility was terminated or revoked ........ 12 M M D D Y Y Y Y
13 Total recapture of apportioned credit for qualified facilities: Enter the total amount(s) of the credit(s)
previously claimed for the facility(ies) whose certification was terminated or revoked. If more than
one certification has been terminated or revoked, enter the total amount ................................................ 13 00
14 Enter the partner’s portion of this credit to be recaptured from Form 349-P, Part 2, line 7. ...................... 14 00
15 Enter the S Corporation shareholder’s portion of this credit to be recaptured from Form 349-S,
Part 2, line 7. .............................................................................................................................................. 15 00
16 Add lines 13 through 15. Enter the total. This is your total recapture amount .......................................... 16 00
Continued on page 2 
ADOR 11192 (22)

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     Name (as shown on page 1)                                                        EIN

     Part 5    S Corporation Credit Election
 17  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):
           17a  Claim the credit for qualified facilities as shown in Part 3, line 11 (for the taxable year indicated above);
               OR
           17b  Pass the credit for qualified facilities as shown in Part 3, line 11 (for the taxable year indicated above), through to its 
                shareholders.

           Signature                                                    Title                                                                                         Date
If passing the credit through to the shareholders, complete Form 349-S for each shareholder.
           •  Provide a completed copy of Form 349-S to each shareholder.
           •  Include a copy of each completed Form 349-S with your tax return.
           •  Keep a copy of each completed Form 349-S for your records.

     Part 6    Partnerships
Partnerships passing the credit through to its partners, complete Form 349-P for each partner.
           •  Provide a completed copy of Form 349-P to each partner.
           •  Include a copy of each completed Form 349-P with your tax return.
           •  Keep a copy of each completed Form 349-P for your records.

     Part 7    Credit Recapture Summary
 18        Enter the taxable year(s) in which you took a credit for a business as a qualified facility whose 
           certification has been terminated or revoked:

 19  Total amount of credit recaptured:
           •   Individuals, C Corporations, S Corporations, and exempt organizations with UBTI: 
               Enter the amount from Part 4, line 16.
           •   Individuals that did not make the Small Business Income election:  Also, enter this amount  
               on Form 301, Part 2, line 29.
           •   Individuals that made the Small Business Income election:  Also, enter this amount on  
               Form 301-SBI, Part 2, line 22
           •   C Corporations, S Corporations that claimed this credit at the corporate level, and exempt 
               organizations with UBTI:  Also, enter this amount on Form 300, Part 2, line 21 ...................................                                  19                00

     Part 8    Total Apportioned Credit Claimed This Taxable Year
 20        Total apportioned credit for qualified facilities:
           •   Individuals, C Corporations, S Corporations claiming this credit at the corporate level, and 
               exempt organizations with UBTI:  Enter the amount from Part 3, line 11.
           •   Partnerships:  Enter “0”.
           •   S Corporations electing to pass this credit through to individual shareholders:  Enter “0”.
           •   Individuals that did not make the Small Business Income election:  Also, enter this amount   
               on Form 140, line 58; or Form 140NR, line 65; or Form 140PY, line 67; or Form 140X, line 45.
           •   Individuals that made the Small Business Income election:  Also, enter this amount on  
               Form 140-SBI, line 58; or Form 140NR-SBI, line 56; or Form 140PY-SBI, line 58; or  
               Form 140X-SBI, line 58. 
           •   C Corporations:  Also, enter this amount on Form 120, line 22; or Form 120A, line 14; or 
               Form 120X, line 22(c).
           •   Exempt organizations with UBTI:  Also, enter this amount on Form 99T, line 12.
           •   S Corporations that claimed this credit at the corporate level:  Also, enter this amount on 
               Form 120S, line 20 ................................................................................................................................ 20                00

ADOR 11192 (22)                                                  AZ Form 349 (2022)                          Print                                                        Page 2 of 2

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