Maine Media Production Wage Reimbursement Application

Media Production Wage Reimbursement Application
2023 Form 841ME
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Form 841ME

Maine Revenue Services
Certified Visual Media Production
Wage Reimbursement Application

	 Certified Production Company Name	

EIN

	 Name of Production
	 Address	
	 City	

Production Start Date
State	

ZIP Code	

Production End Date

1.	 Certified production wages paid to Maine resident individuals
(Schedule 2, line 3 plus Schedule 3, line 3).............................................................................. 1.	$___________________ .00
2.	 Reimbursement requested for Maine resident individuals. (Multiply line 1 by 12% (0.12).)...... 2.	$___________________ .00
3.	 Certified production wages paid to nonresident individuals.
(Schedule 2, line 4 plus Schedule 3, line 4.)............................................................................. 3.	$___________________ .00
4.	 Reimbursement requested for nonresident individuals. (Multiply line 3 by 10% (0.10).)........... 4.	$___________________ .00
5.	 Total certified production wages (line 1 plus line 3)................................................................... 5.	$___________________ .00
6.	 Total reimbursement requested (line 2 plus line 4).................................................................... 6. 	 $___________________ .00

Note:	

Complete and attach Schedule 2. Also complete and attach Schedule 3, if required. Reimbursement requests will not be
processed until a properly completed Schedule 2 and/or Schedule 3 are received by Maine Revenue Services ("MRS").
Attach a copy of the certified visual media production report submitted to the Department of Economic and Community
Development.

	

MRS may request additional information supporting the reimbursement claimed before the application can be processed.

Under penalties of perjury, I declare that I have examined this application and accompanying schedules and statements and to the
best of my knowledge and belief they are true, correct and complete. Declaration of preparer (other than taxpayer) is based on all
information of which preparer has any knowledge.
Signature:____________________________________________________	Date:_______________________________
Title:________________________________________________________	Telephone:_______________________________
Paid Preparer’s EIN:___________________________________________

Contact Person’s Name:________________________________________	Telephone:_______________________________
Contact Person’s Email Address:__________________________________	
Mail To:	

Maine Revenue Services
	P.O. Box 1064
Augusta, ME 04332-1064
Revised: December 2023

Schedule 2 (Form 841ME) -- Certified Production Company Employees and
	
Non-Employee Performing Artists
Certified Production
Company Name:	 _______________________________________________________

	___________________________	
	

EIN	

/

/

/

/

______ ______ ____________	______ ______ ____________

Production Start Date	

Production End Date

List below information relating to amounts claimed on Form 841ME, lines 1 and 3. (See instructions.)
Column 1	
Column 2	
	
Employee or Performing	
Social Security Number	
	
Artist Name		
			
	

			

a.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

	

b.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

c.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

d.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

e.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

f.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

g.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

h.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

i.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

j.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

k.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

l.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

m.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

n.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

o.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

p.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

q.	 _________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

Column 3/4	
Column 5	
Nonresident/	
# of Days	
Non-employee	 Worked in	
Performing Artist	 Maine
3		
4

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Column 6
Certified Production
Wages

________ 	

$___________________ .00

________ 	

$___________________ .00

________ 	

$___________________ .00

________ 	

$___________________ .00

________ 	

$___________________ .00

________ 	

$___________________ .00

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$___________________ .00

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$___________________ .00

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$___________________ .00

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$___________________ .00

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$___________________ .00

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$___________________ .00

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$___________________ .00

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$___________________ .00

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$___________________ .00

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$___________________ .00

1.	 Total resident certified production wages this page...................................... 1.	

$___________________________________ .00

2.	 Total nonresident certified production wages this page................................ 2.	

$___________________________________ .00

3.	 Total resident certified production wages for all Schedule 2 pages
	 (enter here and on Form 841ME, line 1)....................................................... 3.	

$___________________________________ .00

4.	 Total nonresident certified production wages, all Schedule 2 pages
	 (enter here and on Form 841ME, line 3)....................................................... 4.	

$___________________________________ .00

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Schedule 3 (Form 841ME) -- Temporary Employee-Leasing Company Employees
Certified Production
Company Name:	 ______________________________________________________________________________________________________

/

/

/

/

___________________________	______ ______ ____________	______ ______ ____________

EIN	

Production Start Date	

Production End Date

_______________________________________________________ 	

_____________________________

Employee Leasing Company Name		

EIN

List below information relating to amounts claimed on Form 841ME, lines 1 and 3. (See instructions.)
Column 1	
Column 2	
Column 3	
Column 4	
	
Employee Name	
Social Security Number	
Nonresident	 # of Days	
				
Worked in	
				Maine
	

a.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

b.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

c.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

d.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

e.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

f.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

g.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

h.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

i.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

j.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

k.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

l.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

m.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

n.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

o.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

p.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

q.	 __________________________ 	

___ ___ ___ - ___ ___ - ___ ___ ___ ___	

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Column 5
Certified Production
Wages

________ 	

$____________________ .00

________ 	

$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

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$____________________ .00

1.	 Total resident certified production wages this page.....................................................1.	 $________________________________ .00
2.	 Total nonresident certified production wages this page...............................................2.	 $________________________________ .00
3.	 Total resident certified production wages for all Schedule 3 pages
	 (enter here and on Form 841ME, line 1)......................................................................3.	 $________________________________ .00
4.	 Total nonresident certified production wages, all Schedule 3 pages
	 (enter here and on Form 841ME, line 3)......................................................................4.	 $________________________________ .00

Certified Visual Media Production Wage Reimbursement
General Instructions

The visual media production tax incentive provides for a partial reimbursement of certified production wages paid to employees
working on a visual media production in Maine. The first $50,000 paid to each individual performing personal services in
Maine in connection with a certified visual media production is eligible for the wage reimbursement. The reimbursement rate
is 12% for residents of Maine and 10% for nonresidents. Certified productions wages include:
	
1.	Wages paid by the visual media production company to an employee for work performed in Maine in
		 connection with a certified visual media production that will be reported as Maine wages on Form W-2;
	
2.	An amount paid to a temporary employee-leasing company (e.g. loan-out company) for personal services
		 rendered in Maine by a leased employee in connection with a certified visual media production;
	
3. 	An amount paid for the services of a performing artist for work performed in Maine in connection with a certified
		 visual media production;
	
4. 	Other contractual payments for personal services performed in Maine in connection with a certified visual 		
		 media production.
The visual media production company is responsible for withholding Maine income taxes from its employees who work in
Maine. A loan-out company is responsible for withholding Maine income taxes from employees of the loan-out company who
are performing services for the production company in Maine.
The process required to receive the reimbursement is outlined below.
Required Certificates. The visual media production company must obtain certification from the Department of Economic
and Community Development (“DECD”). The certificate is applied for prior to the start of the production. A visual media
production certificate is issued to the visual media production company meeting all initial program requirements. Once the
media production certificate is obtained, the business may begin the qualified production. Within four weeks after completion
of the qualified production, the business must submit a certified visual media production report to DECD.
Certified Visual Media Production Wage Reimbursement. To claim the wage reimbursement, the business must file a
reimbursement application, Form 841ME, Schedule 2 and Schedule 3 (if applicable) with MRS within six weeks of filing the
certified visual media production report with DECD. Eligible reimbursements will be paid within 90 days after the assessor
received a complete application. Only certified production wages up to $50,000 for each individual may be used to calculate
the wage reimbursement.
You must attach a copy of the certified visual media production report submitted to DECD.

Specific Instructions
If applicable, complete Schedules 2 and 3 before completing Form 841ME.
Form 841ME
Enter name, address, city, state, ZIP code, federal employer identification number (FEIN), and production dates in the
appropriate boxes.
Schedule 2
All filers requesting reimbursement must complete Schedule 2 for compensation paid directly to individuals for personal
services performed in Maine during the production period (wages paid to employees and payments made to non-employee
performing artists).
Column 1.	 Enter the last name, first name and middle initial for each certified production employee and non-employee
performing artist who earned wages or payments during the production period.
	

Employees of temporary employee-leasing and loan-out companies must be reported separately on Schedule 3.

Column 2.	 Enter the social security number for each individual listed in column 1.
Column 3.	 Enter an “X” in the box if the individual in column 1 is not a resident of Maine.
	

If the individual is a Maine resident, the media production company must retain a copy of the individual’s
Certified Media Production Residency Affidavit on file for at least three years. This form is available on the MRS
website at www.maine.gov/revenue/tax-return-forms.

Certified Visual Media Production Wage Reimbursement
Specific Instructions, continued
Column 4.	 Enter an “X” in the box if the individual in column 1 is a non-employee performing artist.
Column 6.	 Enter the certified production wages for each individual listed in column 1. Certified production wages are
wages and other payments made during the certified visual media production period for personal services
performed with respect to the production. The wages must have been subject to Maine income tax withholding
to qualify. Certified production wages do not include payment in excess of $50,000 made to any single individual
for personal services rendered in connection with a particular certified visual media production. 36 M.R.S.
§ 6901(2). Do not include payments for personal services provided by employees of an employee-leasing
company or loan-out company; these employees must be listed on Schedule 3.
Line 1.	

Enter the total certified production wages for Maine resident individuals listed on the page.

Line 2.	

Enter the total certified production wages for nonresident individuals listed on the page.

Line 3.	

Enter the sum of Maine resident certified production wages for all pages of Schedule 2 submitted. Also, enter
this amount, combined with the amount from Schedule 3, line 3, on Form 841ME, line 1.

Line 4.	

Enter the sum of nonresident certified production wages for all pages of Schedule 2 being submitted. Also,
enter this amount, combined with the amount from Schedule 3, line 4, on Form 841ME, line 3.

Schedule 3
All filers requesting reimbursement must complete Schedule 3 for payments made to temporary employee-leasing
companies (including loan-out companies) for employees performing personal services directly related to the certified
media production. For purposes of Form 841ME and Schedule 3, these payments are also known as certified production
wages. Complete a separate Schedule 3 for each temporary employee-leasing and loan-out company to which payments
were made. Only include the portion of payments for personal services.
Column 1.	 Enter the last name, first name and middle initial for each temporary employee-leasing company employee
who earned wages during the production period.
Column 2.	 Enter the social security number for each individual listed in column 1.
Column 3.	 Enter an “X” in the box if the individual in column 1 is not a resident of Maine.
	

If the individual is a Maine resident, the media production company must retain a copy of the individual’s
Certified Media Production Residency Affidavit on file for at least three years. This form is available on the MRS
website at www.maine.gov/revenue/tax-return-forms.

Column 5.	 Enter the payments made to the temporary employee-leasing company or loan-out company with respect
to each individual listed in column 1. The payments must be directly related to the certified visual media
production. Do not enter amounts in excess of $50,000 paid for any single individual for personal services
rendered in connection with a particular certified visual media production. 36 M.R.S. § 6901.
Line 1.	

Enter total payments for Maine resident individuals listed on the page.

Line 2.	

Enter total payments for nonresident individuals listed on the page.

Line 3.	

Enter the sum of Maine resident payments for all pages of Schedule 3 submitted. Also, enter this amount,
combined with the amount from Schedule 2, line 3, on Form 841ME, line 1.

Line 4.	

Enter the sum of nonresident payments for all pages of Schedule 3 submitted. Also, enter this amount, combined
with the amount from Schedule 2, line 4, on Form 841ME, line 3.

Important: If all required lines and schedules are not completed, your reimbursement request cannot be processed.