Florida Renewable Energy Technologies Investment Tax Credit Program Application INSTRUCTIONS Florida Corporate Income Tax Credits will be issued in accordance with F.S. 220.192, on a first-come, first-served basis, based upon the date complete applications are received and upon availability of funding. COVER SHEET General Information: Provide the requested information for the purchaser along with background information on the renewable energy project. Summary of Sales Tax Paid: Provide a total for each category which applicant is seeking Florida sales tax exemption. Applicant Certification: Applicant must sign to certify compliance with F.S. 220.192. The project manager must sign to certify as well. DETAIL SHEETS For each category applying for: Complete the accompanying Detail Sheet. Provide an itemized list of eligible costs and description of all equipment, machinery and other materials for which applicant is seeking a credit. SUBMISSION PROCESS 1. Submit a signed copy of the enclosed application form with supporting documentation via certified mail or hand delivered to: Florida Department of Environmental Protection (DEP) ATTN: Renewable Energy Technologies Investment Tax Credit Program Florida Energy Office 2600 Blair Stone Road, MS-19 Tallahassee, FL 32399-2400 NOTE: Incomplete applications will be taken out of queue upon determination of incompleteness. 2. Completed applications will be processed, certified by DEP, and returned to the applicant. 3. Once your DEP application has been approved and returned, attach the DEP certification to the tax return of which the credit is claimed. 1 DEP Form 62-16.900(4) (XX-XX-06)
Florida Renewable Energy Technologies Investment Tax Credit Program Application General Information Applicant Company/Taxpayer Name: Authorized Corporate Officer: Street Address: City/State/Zip: County: Phone Number: Tax Year End Date: FEIN/Tax ID Number: Business Partner Number: Application Submittal Date: Project Background Project Name: Project Location: Lead Organization: Project Manager: Phone Number: Summary of Eligible Expenditures Hydrogen Vehicles & Infrastructure: $ Stationary Hydrogen Fuel Cells: $ Biodiesel & Ethanol Distribution: $ Total Eligible Expenditures: $ NOTE: Complete description of all eligible costs and other supporting documentation shall be attached to this form. Applicant Certification Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, all information contained in the application, including all records of eligible costs claimed as a basis for the tax credit, are true and correct, and the requirements of Section 220.192 Florida Statutes, have been met. Authorized Corporate Officer Signature Printed Name and Title Date Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, no other Florida sales tax refund claim has been made for the materials identified in this application. Project Manager Signature Printed Name and Title Date FOR OFFICIAL USE ONLY - To be completed by the Florida Department of Environmental Protection (DEP) Total Amount of Credit Approved (75% of Eligible Expenditures): $ Date & Time Received DEP Authorizing Signature Printed Name Date Date Signed Application Returned to Applicant/Purchaser: Date Copy of Application Forwarded to the Department of Revenue: 2 DEP Form 62-16.900(4) (XX-XX-06)
DETAIL SHEET: Hydrogen Vehicles & Infrastructure Hydrogen Vehicles & Infrastructure for which applicant is seeking a credit. Additional pages may be used. Place all supporting documentation for Hydrogen Vehicles & Infrastructure expenditures immediately following this page. 3 DEP Form 62-16.900(4) (XX-XX-06)
DETAIL SHEET: Stationary Hydrogen Fuel Cells Stationary Hydrogen Fuel Cells for which applicant is seeking a credit. Additional pages may be used. Place all supporting documentation for Stationary Hydrogen Fuel Cells expenditures immediately following this page. 4 DEP Form 62-16.900(4) (XX-XX-06)
DETAIL SHEET: Biodiesel & Ethanol Distribution Biodiesel & Ethanol Infrastructure for which applicant is seeking a credit. Additional pages may be used. Place all supporting documentation for Biodiesel & Ethanol Infrastructure expenditures immediately following this page. 5 DEP Form 62-16.900(4) (XX-XX-06)