Schedule

EOTC-1                 Economic Opportunity Tax Credit
Rev. 10-15                                    (For periods AFTER January 1, 2015)

                                                     Tax Year:
Beginning:                                                           Ending:

                  MM                          YYYY                               MM              YYYY
NAICS                                                       FEIN, TID, 
Code                                                              or SSN
Business Name: ___________________________________________________________________
Street Address: ____________________________________________________________________
________________________________________________________________________________
City, Town or Post Office: ____________________________ State: _________  Zip Code_________
                                            Certified Multiple Year Projects
1. Investment Year(s): 1.                            2.                               3.

2. Investment Summary:                        Cost          Percentage                Qualified
   Investment with Useful Life of 4-6 years                       x 33.33%
   Investment with Useful Life of 6-8 years                       x  66.66%
   Investment with Useful Life of 8+ years                  x 100.00%
   Total Qualified Investment                                                  4.

                                                   New Jobs Percentage
   If number of new jobs created is at least [Small Business Only]         10           then                 10%
   If number of new jobs created is at least [Corp. Headquarters Only]     15           then                 10%
   If number of new jobs created is at least                               20           then                 20%
   If number of new jobs created is at least                               280          then                 25%
   If number of new jobs created is at least                               520          then                 30%
   Add 5% to new jobs percentage if you employ at least 75 full-time equivalent construction 
   workers at prevailing wage in $20 million or greater investment project.
3. Available Credit Calculation:
     Qualified Investment                   X New Jobs Percentage    =     Tax Credit   X        10% / year

4. Pro-Rated Credit Allocation Summary at 10% per year for 10 years [Multiple year projects only]
   Year Available               Year 1             + Year 2        +    Year 3   =               Total Credit
                                                   +               +             =
                                                   +               +             =
                                                   +               +             =
                                                   +               +             =
                                                   +               +             =
                                                   +               +             =
                                                   +               +             =
                                                   +               +             =
                                                   +               +             =
                                                   +               +             =
Schedule EOTC-1 — Rev. 10-15                                                                     Page 1 of 2

5. Annual New Jobs/Payroll Factor Computation              Number of Employees             Payroll of Employees
   a. Pre-Credit Employment Levels:
      New-Jobs Employed for Credit:
      Total Employment in WV:
   b. Payroll Factor:        New Jobs Payroll              Total WV Payroll                Payroll Factor
                                                   /                                   =
6. Annual Tax Offset Factor:
   If Median compensation of new jobs is at least $40,198 (for 2015) then tax offset is 100%. Otherwise tax offset is 
   80%. Median compensation for this year is ______________________________. (See Administrative Notices for values 
   for other years.)

                                          TAx CredIT ApplICATIon CompuTATIon
7. A. Tax Subject to Credit Offset

   Tax Type Pre-Credit Liability          X Payroll Factor        X Offset Factor      = Tax Subject to Credit Offset
   B&O                                    X                       X                    =
   CNIT                                   X                       X                    =
   PIT*                                   X                       X                    =
   TOTAL                                  X                       X                    =
   B. Economic Opportunity Credit Applied
                                            Tax Subject to Credit          Tax Credit 
   Tax Type Pre-Credit Liability            Offset                         Applied         After Credit Net Tax
   B&O
   CNIT
   PIT*
   TOTAL
   * Individual Shareholders of S corporations and partnerships will also need to file a Personal Income Tax credit schedule.
8. Tax Credit Recap
   a. Total credit pro-rated for this year
   b. Unused credit carryover from last year                                           +
   c. Total credit available this year                                                 =
   d. Total credit used this year (sum of “tax credit applied column of Section 7B)
   e. Credit remaining for carryover to next year (subtract amount on line 8d from the 
      amount on line 8c, and enter here [if the next year is year 13, enter $0])

Under penalties of perjury, I declare that I have examined this credit claim form (including accompanying schedules and 
statements) and to the best of my knowledge it is true and complete.

Signature of Taxpayer                     Name of Taxpayer (type or print) Title           Date

Person to contact concerning this return                                   Telephone Number

Signature of Preparer other than Taxpayer Address                                          Date

Schedule EOTC-1 — Rev. 10-15                                                                   Page 2 of 2