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                        Application for West Virginia Economic Opportunity Tax Credit
EOTC-A
Rev. 03/2020            For Investments Placed in Service On or After January 1, 2003

BUSINESS NAME                                                                  IDENTIFICATION NUMBER

   TAX YEAR                                                         TO
                     MM           DD                YYYY                       MM            DD             YYYY

NAME OF TAXPAYER                                                 PERSON TO CONTACT CONCERNING THIS RETURN

ADDRESS                                                                        PREPARER’S EIN

CITY, STATE, ZIP                                                                  DAYTIME TELEPHONE

Application is hereby made to the Tax Commissioner of West Virginia for allowance of Economic Opportunity Tax Credit with 
respect to quali ﬁed investment property placed in service or use during Applicant’s tax year, as indicated above, and the 
new jobs created by the Applicant that are directly attributable to the quali ﬁed investment property that are  ﬁlled by persons 
who are domiciled in this State.

1. a.   Application Status (Check only one):
        a.)  One Year Investment, One Taxpayer
        b.) Multiple Year Investment, One Taxpayer – Must receive Certi ﬁ     cation from Tax Commissioner

Note: An application must be  ﬁled for each year in which investment for purpose of the Economic Opportunity Tax 
Credit is placed in service or use. Additionally, the application must be approved by the State Tax Commissioner 
before any credit may be claimed.
b.      Type of Credit:         Regular Credit          Headquarters Relocation                   Small Business
                                Speci ﬁed High Technology Manufacturer                             Other (See instructions)

2. a.   Investment                                       Total Investment                    Quali ﬁed Investment
        Year-1 (ending)                         Amount $                                     $
                        MM      DD       YYYY
        Year-2 (ending)                         Amount $                                     $
                        MM      DD       YYYY
        Year-3 (ending)                         Amount $                                     $
                        MM      DD       YYYY

b.      Location(s) of Investment in West Virginia       ___________________________________________________

c.      General Description of Quali ﬁed Investment:

EOTC-1                                                                                                           Page 1 of 2
Rev. 03/2020

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BUSINESS NAME IDENTIFICATION NUMBER

Payroll and Employment: Payroll Jobs

3 a. . Total WV Payroll and Number of Jobs Prior to investment $

b. Total WV Payroll and Number of Jobs This Tax Year $

c. Projected WV Payroll and Number of Jobs After 3 Years: $
d. Jobs Percentage (see Instructions) and Projected Number
of Jobs After 3 Years: %
e. Median Compensation of New Jobs (Credit Type: High
Technology Manufacturers): $

f. Minimum Compensation of New Jobs (Credit Type: Other) $

Percentage of Employees Average Annual Cost per Number of New Jobs
Bene ﬁts Covered Employee with the Bene ﬁt

4 a. . Health % $

b. Retirement % $
c. Other Bene ﬁts (Provide Description and Quantities )
%$

Business Activity in West Virginia:
5 a. North American Industry Classi ﬁcation System Code (NAICS): _________________________

b. Narrative Description of Business Activity in West Virginia:
_________________________________________________________________________________________________
_________________________________________________________________________________________________

6. Does the Taxpayer elect to begin the ten (10) year credit period with the next succeeding taxable year? yes no

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)

DO NOT attach the Application to your annual return. Return the completed application to the West Virginia State Tax
Department, P.O. Box 1202, Charleston, WV 25324-1202. If you have any questions or need further information regarding
this application, telephone (304) 558-3333 or toll free to 1-800-WVA-TAXS (1-800-982-8297).
EOTC-1 Page 2 of 2
Rev. 03/2020

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                                         Form EOTC-A

                 APPLICATION FOR WEST VIRGINIA ECONOMIC OPPORTUNITY AXT  C                                REDIT

                 F ORI    NVESTMENTS     PLACED   SIN   ERVICE O   N ORA            FTER JANUARY   1, 2003

                                                   Information & Instructions

The Economic Opportunity Tax Credit is available to qualifi ed  For purposes of the Specifi ed High Technology Manufacturer 
businesses that make a qualifi ed investment (on or after January  component of the Economic Opportunity Tax Credit, the term 
1, 2003) in a new or expanded business in West Virginia and, as  “high technology manufacturing business” means and is limited 
a result of this investment, create new jobs. Qualifi ed businesses  to only those businesses engaging in a manufacturing activity 
include only those engaged in the activities of manufacturing,  properly classifi ed as having one or more of the following six-digit 
information processing, warehousing, non-retail goods distribution,  North American Industry Classifi cation System code numbers:
qualifi ed research and development, the relocation of a corporate 
headquarters, or destination-oriented recreation and tourism. The     NORTH AMERICAN INDUSTRY      MANUFACTURING ACTIVITY
minimum job creation requirements are as follows:                     CLASSIFICATION SYSTEM CODE
                                                                           334111                 Computer & Peripheral Equipment
        TYPE OF   CREDIT                 MINIMUM N  JEW OBS                334112                  Electronic Computers
                                                                                                  Computer Storage Devices
Regular                                            20                                              Electronic Components
                                                                           334411
Corporate Headquarters Relocation                  15                      334414                         Electron Tubes
Small Business                                     10                                              Electronic Capacitors
Specifi ed High Technology Manufacturer 20 (Additional criteria)           334413                         Semiconductors
Other Qualifi ed Business                1 (Additional criteria)           333295                 Semiconductor & Related Devices
                                                                                                   Semiconductor Machinery

The law provides that the required net increase in the taxpayer's  Additionally, the Economic Opportunity Tax Credit Law requires 
employment in the State be determined and certifi ed for a  that the median compensation of the new jobs attributable to 
controlled group instead of an individual subsidiary. Jobs saved  the qualifi ed investment must exceed an infl ation adjusted value. 
by the making of investment in an ongoing business operation  Through tax year 2009, the infl ation median compensation value 
do not count toward the new employee requirement unless the  by tax year is as follows:
Tax Commissioner determines that the taxpayer is insolvent or 
bankrupt or that the taxpayer’s business facility was destroyed by                                CRITERIA
fi re, fl ood, or act of God.                                                                             MEDIAN 
The term “full-time employment” is defi ned to mean employment                               YEAR  COMPENSATION
for at least one hundred forty (140) hours per month. The term                               2008         $45,000
“small business” is defi ned to mean a business or controlled group                          2009         $46,900
of foreign and domestic affi  liated businesses with annual gross 
receipts of not more than an infl ation adjusted ceiling amount.      Current information on the median compensation value can be 
Through tax year 2009, the infl ation adjusted gross receipts ceiling found on the Administrative Notice section at http://tax.wv.gov.
by tax year is as follows.
                                                                      Taxpayers engaged in manufacturing, information processing, 
                                                                      warehousing, non-retail goods distribution, qualifi ed  research 
                              CRITERIA
                                                                      and development, the relocation of a corporate headquarters, or 
                 YEAR             GROSS RECEIPTS                      destination-oriented recreation and tourism who do not satisfy 
                 2003                   $7,000,000                    the new jobs creation requirements for the Regular, Corporate 
                 2004                   $7,159,600                    Headquarters Relocation, Small Business, or Specifi ed  High 
                 2005                   $7,324,500                    Technology Manufacturers components of the Economic 
                 2006                   $7,552,050                    Opportunity Tax Credit may qualify for a credit equal to $3,000 
                                                                      per new job annually for fi ve years. Each new job must satisfy the 
                 2007                   $7,846,850
                                                                      following requirements:
                 2008                   $8,026,350
                 2009                   $8,368,450                    1.  Pay at least $32,000 annually;
                                                                      2.  Provide health insurance and may off er benefi ts including 
Current information on the gross receipts ceiling can be found on      child care, retirement or other benefi ts; and
the Administrative Notice section at http://tax.wv.gov.               3.  Is a full-time permanent position.
                                                                      Finally, the law specifi es that no credit may be allowed or applied for

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any qualifi ed investment property placed in service until the person  invested in buildings, $500,000 to be invested in land, etc.).
asserting a claim for the credit makes written application to the 
Tax Commissioner and receives written acknowledgement or such            PAYROLL & EMPLOYMENT
application from the Tax Commissioner. Failure to timely apply for 
credit will result in forfeiture of 50% of the annual credit allowance    Enter your total West Virginia payroll and number of 
otherwise available under this requirement. Form EOTC-A is                jobs attributed to that payroll for the twelve month 
designed to be a general application form for taxpayers wishing to       period ending on the day prior to the day of the fi rst placement of 
claim the credit based upon investments placed into use or service       qualifi ed investment subject to Economic Opportunity Tax Credit 
on or after January 1, 2003. The timely fi ling of this application is a into service or use.
condition precedent to claiming tax credits. This application must 
be fi led annually no later than the due date of the taxpayer’s West      Enter your total West Virginia payroll and number of jobs 
Virginia income tax return including any legally granted extension        attributed to that payroll for the tax year to which this 
of time for fi ling such returns.                                        application relates.

APPLICATION STATUS                                                        Enter your total projected  West  Virginia payroll and 
                                                                          number of jobs attributed to that payroll for the third tax 
      Place a check mark in the box next to the applicable status        year after the qualifi ed investment is fi rst placed into service or 
      of your investment (Check only ONE box).                           use. For example, if you fi rst plan to place investment into service 
                                                                         or use in 2003 then, you would use your projected 2005 payroll to 
      (a.)  In some cases qualifi ed investment property is placed in 
                                                                         complete this question (Note: The information in 3b and 3c should 
      service or use by the taxpayer over a single tax year.
                                                                         be identical if this year is your third tax year).
      (b.)  However, a multiple year project certifi cation enables 
      the taxpayer to place investment into service over a 
      period of up to three consecutive tax years.                        Enter the applicable jobs percentage you wish to claim 
                                                                          (i.e. 20% if you expect to create at least 20 new jobs) and 
Note: An Application must be fi led for each year in which  your projected number of new jobs created up through the third tax 
investment for purposes of the Economic Opportunity Tax Credit           year corresponding to the increase in payroll from 3a to 3c. Note: 
is placed in service or use. Additionally, the application must be       The new jobs percentage is applicable to the Regular, Corporate 
approved by the State Tax Commissioner before any credit may  Headquarters Relocation, and Small Business components of the 
be claimed.                                                              Economic Opportunity Tax Credit.

      Type of credit: Place a check mark in the box indicating                               N EWJOBS    PERCENTAGE TABLE
      the type of credit application sought (Check on ONE                 Number of New Jobs                       New Jobs Percentage
box).                                                                    10 to 19 (small business only)                    10%
                                                                         15 to 19 (Corporate HQ relocation only)           10%
INVESTMENT
                                                                         20 to 279                                         20%
      Enter the year investment is placed into service or use in         280 to 519                                        25%
      the fi rst column, the total dollar amount of investment           520 or more                                       30%
placed into service or use in the second column and the dollar 
amount of qualifi ed investment placed into service or use in the        Note that is your business is a member of a controlled group, then 
third column. Qualifi ed Investment is determined according to the       the controlled group’s West Virginia employment must show a 
following useful life (straight line depreciation):                      new increase equal to or greater than the necessary minimum new 
                                                                         jobs threshold claimed by the member for credit to be available. 
               Useful Life                                               For projects having qualifi ed investment of $20 million or more 
                                                                         that are constructed using construction labor and mechanics 
      At Least        But Less Than      Percent Qualifi ed
                                                                         numbering 75 or more employees or equivalent employees, who 
      0 years              4 years                  0%                   are paid an average wage of at least prevailing wage; the new jobs 
      4 years              6 years                  33%                 percentage for the 20 or 520 employee range is increased by 5 
      6 years              8 years                  66%                 percentage points.

8 or more years                                     100%
                                                                          If the box for “Specifi ed High Technology Manufacturer” 
                                                                          in 1b (i.e., Type of Credit) was checked, enter the value of 
      Enter the physical location(s) of the qualifi ed investment        the median compensation for the new jobs created.
      property (e.g., Main Street, Weston, or 12 miles north of 
Pipestem at the Intersection of State Route 3 and State Route 20).
                                                                          If the box for “Other” in 1b (i.e.,  Type of Credit) was 
                                                                          checked, enter the value of the minimum compensation 
      Provide a general description of the qualifi ed investment         for the new jobs created.
      property in the space provided (i.e. $100,000 to be

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BENEFITS                                                                  Describe the business expansion activity in  West 
                                                                          Virginia that is associated with your new investment 
 Health insurance – Enter the percentage of your                   (e.g., construction of a reconstituted wood product manufacturing 
 employees covered, the average annual cost per employee           plant).
(i.e., benefi t costs divided by number of covered employees), and 
the number of new jobs with health insurance.                      CREDIT PERIOD

 Retirement – Enter the percentage of your employees                      Taxpayers have an option of beginning their utilization 
 covered, the average annual cost per employee (i.e. benefi t             of tax credits with the year investment is fi rst  placed 
costs divided by number of covered employees), and the number of  into service or with the succeeding taxable year. Check yes or no 
new jobs with company-provided retirement benefi ts.               depending upon which option you choose. Once an election is 
                                                                   made either way it becomes irrevocable.
 Other Benefi ts – List other company benefi ts provided 
                                                                   Within a reasonable time after receipt of the Application the 
 (e.g., child care) and enter the percentage of your 
                                                                   State Tax Commissioner or his designee will acknowledge, in 
employees covered, the average annual cost per employee (i.e., 
                                                                   writing, receipt, of this application and authorize the Applicant to 
benefi t costs divided by number of covered employees), and the 
                                                                   begin claiming Economic Opportunity Tax Credit benefi ts. Such 
number of new jobs with the benefi t.
                                                                   acknowledgement and authorization will not bar or otherwise 
                                                                   prevent the  Tax Commissioner from auditing or examining 
BUSINESS ACTIVITY IN   WEST VIRGINIA
                                                                   Applicant’s books and records for compliance with the Economic 
 Enter your North American Industry Classifi cation                Opportunity Tax Credit law and regulations.
 Code (NAICS) that most closely describes your business 
                                                                   This application must be signed by an offi  cer of the company to 
activity in West Virginia.
                                                                   be valid. ❦

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