Fill and Sign the Pl400dc Individual Life Insurance Application Protective Life Can Only Accept or Service an Application from an Applicant Who Form

Attach this form to your account now through Revenue Online. Visit www.Colorado.gov/RevenueOnline today! 1. Click on Individual or Business. 2. Click on the E-Filer Attachment button under AccessNow. Scroll down to view your form. Note: Fill-in forms are not saveable and will not file the return for you. You must print the return and mail it. We recommend you file through Revenue Online. Return to the Form Web page and click on eFile. DR 0085 (10/07/10) Colorado Department of revenue taxpayer service division room 240 Denver, Colorado 80261-0005 Aircraft manufacturer new employee credit progress report Information is for tax year ending__________________________ , 20_ _____________ Check here if a progress report has been filed for this facility in a prior year Taxpayer/ Company Name Business Telephone Number Business Address Date facility began operations at this facility City, State, ZIP Did this facility relocate from another Colorado location? yes no Aviation Development Zone/ Airport Name Chief Officer (only if taxpayer is a C corporation) Credit Computation Month Number of employees at end of month a b c d e f g h Total 1. Average number of aviation zone employees for year, line m divided by 12..................................................................................... 2. Prior employee base for computing the credit.................................. 3. New aviation zone employees, line 1 minus line 2........................... 4. Credit per new aviation zone employee............................................ $ 1,200.00 5. Aircraft manufacturer new employee credit, line 3 times line 4......... $ .00 6. Average annual compensation, including benefits, paid to the full-time employees employed at this facility during the current year.. $ 7. Average number of aviation zone employees at this facility during the prior year..................................................................................... i 8. Has the taxpayer reduced employment at any other site in j Colorado that is controlled by the aircraft manufacturer? k If yes, check all of the following that caused this reduction: merger acquisition yes no l automation corporate restructuring m other________________________________________________ . Taxpayer signature I declare that all of the above information is true and correct to the best of my knowledge and belief. Signature of Chief Officer/Owner Print Name Title See instructions on back of form for required attachments and mailing information. Date INSTRUCTIONS Form DR 0085 must be completed by any aircraft manufacturer that claims the aircraft manufacturer new employee income tax credit. This report is public record and copies will be available from the Office of Economic Development and International Trade for five years from the due date of the report. The report is due within 90 days of the end of the tax year and must be filed prior to the filing of an income tax return that claims the reported tax credit. This report must be filed with both the Office of Economic Development and International Trade and the Colorado Department of Revenue at the addresses listed below. Attachments Payroll or other data to verify the number of full-time employees reported on this form and for the prior two years must be attached to the form when submitted. Do not include any information that reveals the amount of compensation paid to any individual employee or social security numbers. S corporations, partnerships and other pass-through entities must attach Form DR 0086 to the report filed with the Department of Revenue to identify all shareholders, partners or members and the amount of the credit allocated to each. The information included on the DR 0086 is not public record and will not be released with copies of this progress report. Information See FYI Income 62 at www.TaxColorado.com for additional information regarding the tax credit and the filing of this report. Colorado Department of Revenue Taxpayer Service Division Room 240 Denver CO 80261-0005 www.TaxColorado.com (303) 238-7378 Colorado Office of Economic Development and International Trade 1625 Broadway, Room 1700 Denver CO 80202 www.colorado.gov (303) 892-3840