Rural Area Application for New Employee B&O Tax Credit
                                    Rural Area Application for New Employee 

                                    B&O Tax Credit
                                    Application for tax credits must be made within 90 days after the 
Form 41 0077                        actual hiring of qualified employment positions. A new application 
                                    must be submitted after each group of four consecutive quarters 
Washington State
                                    that you project employment to increase over 15%. Positions 
Department of Revenue
Taxpayer Account Administration     hired after the end of four consecutive calendar quarters are not 
Special Credits & Assessments       considered for this credit. 
PO Box 47476
Olympia WA 98504-7476
360-705-6214

                                                                                       Reset form

Business identification

Name of business: 

Address: 

City:                                                             State:                Zip: 

Name of contact person: 
(All correspondence will be directed to this person.)

Phone: 

Department of Revenue Account ID:    -                - 

Department of Employment Security Identification Number:                   - 

Location of the facility for which job credits are being sought
Please complete one application for each separate facility that is expanding positions.

Check one:             Rural county  Community Empowerment Zone

County:                                 Street address: 

City:                                                             State:                Zip: 

Does the applicant operate in other Washington locations?   Yes   No 
If reporting on credits for more than one facility, please complete an Annual Report for each facility.

To request this document in an alternate format, please complete the form dor.wa.gov/AccessibilityRequest 
or call 360-705-6705. Teletype (TTY) users please dial 711.
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Rural Area Application for New Employee B&O Tax Credit

Business activity to be conducted at this business facility
If additional space is needed please attach additional pages.
Describe your manufacturing activity:

Describe your research and development activities (if applicable):

Is the applicant engaged in the power and light business, other than in-house co-generation?   Yes       No 

General information
Check one:             Business is new.      Business is expanding.
If this is to be a new facility, what is the estimated cost of the project? 

Cost of structure: 

Cost of equipment: 

Total:

Employment information for this facility

1. Enter date of first hire:                Application is due within 90 days of this date.

2. Enter calendar quarter for first hire date (example: Q3/20):              (also enter on 7a below).

3. Enter employment using total FTEs* for the four consecutive quarters BEFORE first hire on lines 3a-3d
   below. (Calendar Quarter example: Q3/19, Q2/20…)
                    Calendar Qtr       Total FTE’s 
                                                   Example: First hire quarter - Q3/20
       3a        Q           /                                       Calendar Qtr      Total FTE’s 
       3b        Q           /                               3a   Q  3 / 19                70 
                                                             3b   Q  4 / 19                72 
       3c        Q           /                               3c   Q         1 / 20         71 
       3d        Q           /                               3d   Q         2 / 20         68
                                                   Add lines 3a-3d:                        281
4. Total all FTEs: Add lines 3a-3d:       0
                                                   Divide line 4 by 4:                     70
5. Average FTEs: Divide line 4 by 4:      0
                                                   Multiply line 5 by 1.15:                80
6. 15% Target: Multiply line 5 by 1.15:   0
   This target is the minimum average for the next
   year to qualify for the credit.

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Rural Area Application for New Employee B&O Tax Credit

7. Calendar Qtr: Enter the first hire quarter and the four consecutive quarters AFTER first hire on lines 7a-
   7e. New FTE positions: Enter the actual number of new FTE positions by salary range. Total FTEs: Enter
   the total number of existing plus new FTE positions.

   Number of new FTE positions

             Calendar Qtr   40K or less   Over 40K     Total FTE’s

    7a Q               / 

    7b Q               / 

    7c Q               / 

    7d Q               / 

    7e Q               / 

8. Total all FTEs: Add Total FTEs from lines 7b-7e:    0
   Do not include 7a in the Line 8 Total FTE’s.

                                                       0
9. Average FTEs: Divide line 8 by 4:
   This number must be greater than the target number on line 6 to qualify for the credit.

* Full Time Equivalent (FTE) positions: Note: Fractional amounts are rounded down. 
Add the hours during a quarter for all part time employees who worked less than 455 hours. Divide this 
number by 455, and add to the total of full time employees. This is the number of FTE positions.

Annual report is required
Annual reports will be required for two years after application. The first annual report, due within 30 days 
of the end of the calendar quarter listed on 7e, will be used to check how many new positions have been 
hired and affirm that the 15% target has been achieved.
The second annual report, due one year after the first report, will be used to confirm that the new 
positions have been retained. See the Annual Report form for additional information.

Future credits
You may apply for future credits in any quarter after Quarter 7e above, as long as each set of four 
consecutive quarters continues to have expansion that meets the 15% increase. A new application for each 
facility is required.

Questions
Call 360-705-6214 for assistance.

Return completed form to:
Taxpayer Account Administration
Special Credits & Assessments
PO Box 47476
Olympia, WA 98504-7476
Fax: 360-705-6173                                                                         Print form
                                                                                      
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