EP-100 State Form #51823 Rev. 05/04 FOR DEPARTMENT USE ONLY Indiana Department of Revenue Ethanol Production Credit Application Approval Amt. Approval Date Indicate period covered for which ethanol was produced: From _______________ to _____________ A. Information Section Company Name TID FID Indiana Location Address City State Zip Code B. Producers 1. Total Ethanol produced in Indiana gallons Note: Maximum total credit a. Indiana Credit (Gallons X .125) = .................................................................... $ per taxpayer is $5,000,000.00 C. Credits Indicate how you anticipate Sales/Use Tax Dollar Amount to be Applied: ... $___________________ using this credit: Adjusted Gross Income Tax .................................................$___________________ Financial Institutions Tax ..................................................... $___________________ Insurance Premium Tax ......................................................... $___________________ Note: The credit can only be applied against sales/use tax liability incurred by the taxpayer. D. Signature Under penalties of perjury, I declare that I have examined this document and to the best of my knowledge and belief, it is true, correct, and complete. ( ) Printed Name and Title Telephone Number Written Signature Date Application and a copy of board certification can be faxed to: (317) 233-3064 or Mail form to: Indiana Dept. of Revenue Ethanol Production Credit 100 N. Senate Ave., Rm. N203 Indianapolis, IN 46204 American LegalNet, Inc. www.FormsWorkflow.com Ethanol Credit (EP-100) Instructions Effective January 1, 2004, Indiana Code IC 6-3.1-28 was enacted providing an ethanol production credit to Indiana producers. This credit is limited to ten million dollars ($10,000,000). The total amount of credit allowed a taxpayer may not exceed five million dollars ($5,000,000) for all taxable years. How soon will I receive my credit approval? The credit applications will be reviewed in the order in which they are received. Processing time will vary depending on the number of applications received. Incomplete applications will be delayed until we are able to obtain the required information. IC 6-3-1-28-2 defines Ethanol as agriculturally derived ethyl alcohol. Who May Apply for this Credit? A producer who is producing ethanol at an Indiana facility with a capacity to produce at least 40,000,000 gallons of ethanol a year and the facility after December 31, 2003, increased its ethanol production capacity by at least forty million (40,000,000) gallons a year. Inquiries regarding processing procedures or the status of your application may be directed to the Compliance Division at 317-232-2339. Where Do I Send My Ethanol Credit Application? Application can be faxed to: (317) 233-3064 or Mail form to: Section A - Information Section 1) Type or print applicant’s name and location address. 2) Enter applicant’s Indiana Taxpayer ID number (TID). 3) Enter applicant’s Federal ID number (FID). Section B - Producers 1) Enter total gallons of ethanol produced at an Indiana location. a) Multiply the number of gallons from Line 1 by $ .125 and enter the dollar amount. This is the amount of the Indiana credit. Section C - Credits Please indicate how you anticipate using this credit by checking the appropriate box(es). Indiana Dept. of Revenue Ethanol Production Credit 100 N. Senate Ave., Rm. N203 Indianapolis, IN 46204 Note: A copy of the board certification for the qualifying facility must be attached or the credit application will be denied. For more information on the certification process, please call the Energy & Recycling Division of the Department of Commerce at 317-232-8940. Where Can I Claim This Credit? The ethanol production credit can be applied as a credit against the taxpayer’s sales/use tax, adjusted gross income tax, financial institution tax, and insurance premium tax. A copy of the approved EP-100 must be attached to the return or the credit will be disallowed. The credit amount approved on the EP-100 is to be taken as a credit against your tax liability on the return of your choice. Please see instructions for your tax returns to determine where the credit should be entered on the various tax forms. What If I Do Not Use All Of My Credit? Reminder: You may not use the credit to offset or reduce the Indiana Gross Retail Sales Tax you collected from your customers. Section D - Signature Any unused credit may be carried over to the next eligible tax return to be filed until all credit has been used. You may claim the credit on more than one return up to the maximum credit approved on the EP-100. This application must be signed by the taxpayer or an authorized agent. If necessary, a properly executed Power of Attorney form must accompany the application. Note: A taxpayer is not entitled to a carryback or refund of any unused credit. The statute does allow for you to carry forward any unused credit. How Often Can I File An Application For Credit? What If I Am An Entity Exempt From Adjusted Gross Income Tax? A claim for credit can be filed monthly, quarterly, semi-annually, or annually. Credits will be approved by the Department until the maximum amount of credit for each category has been reached. Entities exempt from adjusted gross income tax under IC 6-3-2-2.8(2) may “pass through” the credit to shareholders, partners or members of the pass through entity. Each member’s tax credit is calculated by multiplying the total credit available by the percentage of the entity’s distributive income to which the shareholder, partner, or member is entitled. American LegalNet, Inc. www.FormsWorkflow.com