Form IT-40 QEC Fillable Enterprise Zone Qualified Employee Deduction Certificate
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Keep this form with your records (R8 / 9 12) *24100000000* 1 Has a principal place of residency in the enterprise zone where employed; 2 Performs services for the employer 90 percent of which are directly related to the conduct of the employer s trade or business 2410000000 3 Performs services for the employer at least 50 percent of the time during the taxable year within an Indiana state enterprise 4 Is employed by a business that remains eligible to receive benefits and incentives as provided by enterprise zone legislation Address adjusted gross income one half of the enterprise zone income earned for services or $7 500 whichever is less Enterprise zone Amount of compensation for tax year Caution: Limitation of Deduction Certificate City of residence Date of residence in Enterprise Zone: during the period of residence in the Employee s street address Employer Enclosure Enter of the above amount or $7 500 Enterprise Zone Enterprise Zone: $ enterprise zones A qualified employee living and working in a designated enterprise zone may be entitled to deduct from state Federal Identification Number For a listing of all current enterprise zones and contact information for each zone please visit www aiez org/directory html From To I certify that the above named employee was paid the amount indicated as compensation for services rendered and that he/she is a income income means wages salaries commissions and any other forms of remuneration paid to qualified employees for services by an enterprise Indiana Code I C 6 3 2 8 defines a qualified employee as an individual who: Indiana Department of Revenue Instructions for completing Schedule IT 40QEC located in an enterprise zone; must enclose the IT 40QEC with the state individual income tax return to support any claimed deduction of earned enterprise zone Name of employee Name of Enterprise Zone Portions of certain Indiana cities are designated as state enterprise zones Also certain airport development zones may substitute as Privacy Notice: The records in this series are CONFIDENTIAL according to the provisions of I C 6 8 1 7 1 and I C 5 28 15 8 qualified employee as defined in I C 6 3 2 8 Qualified Employee Deduction Schedule IT 40QEC Schedule IT 40QEC is to be completed by the enterprise zone employer and distributed to its qualified employee(s) The qualified employee Sequence No 18 should claim this deduction on IT 40 Schedule 2 IT 40PNR Schedule C or Form IT 40X (amended tax return) The employee Signature of employer Social Security Number State Form 21928 Telephone number Title whichever is less: $ zone employer minus any IRA deductions directly related to that earned income zone; and