Minnesota Amended JOBZ M500 (Revised 1/12)

Amended JOBZ M500 (Revised 1/12)
M500, Reporting of JOBZ Tax Benefits for Tax Year
Amended JOBZ M500 Year

M500X

Use this form to amend Form M500, and to report the sales tax incentives the qualified business received for participating in a Job Opportunity
Building Zone (JOBZ),
Name of qualified business			

Taxpayer name (if different from JOBZ business) 	 JOBZ ID number

Business address in the zone				

FEIN

City	

State	

Minnesota tax ID number

	

MN

Zip code	

County	

	
Taxpayer:

C-Corporation	

S-Corporation	

Partnership	

Individual	

Fiduciary	

Other (specify):

Business contact’s name (first, last)	

Title	

Daytime phone

Email address of qualified business (optional)	

Primary parcel ID (if more than one, attach a sheet)

	

Reason for
amend

Reason for amending Form M500
	

Zone tax benefits
	1	 Did you receive any zone tax benefits in the year you are amending?
		 	 Yes. Continue with line 2.

Zone tax benefits

		 	 No. Explain your situation below, sign at the bottom and file this form by the due date:

Sales tax exemptions
	2	Purchases you made of tangible personal property (not including capital equipment
		 or purchases exempt as a part of product production cost) and services primarily used or
		 consumed in the zone in the year you are amending, that would otherwise have been taxable  . . . . . . . . . . . 2
	3	Purchases you and/or your contractor made of construction materials and supplies
		 used to construct or improve real property used by the qualified business in the zone
		 in the year you are amending  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
	4	Purchases made of motor vehicles that are principally garaged in the zone and primarily used
		 to carry out your zone operations in the year you are amending
		 (enter each vehicle’s VIN number and purchase price; if you have more than 4 vehicles,
		 complete Form M500A, JOBZ Motor Vehicle Purchase Report - see instructions)  . . . . . . . . . . . . . . . . . . . . . . 4
	

	VIN

	 $

	

VIN

		VIN
	 $
	
VIN
	5	Is the qualified business located in an area with			
		 a local sales and use tax (see instructions)?  . . . . . . . . . . . . . . . . . . . . . . . . . .  5 No	
Yes	

Sign here

	I declare that this report is correct and complete to the best of my knowledge and belief.

Rev. 1/12

Signature of authorized representative of qualified business	

Date	

Do not include Form M500 with your tax return.
Mail this form to: 	
		
		
		
		

Minnesota Revenue
Mail Station 9901
St. Paul, MN 55146-9901
Phone: 651-556-6836
Fax: 651-556-3102

	 $

	

	 $
Enter
the area:

	

Form M500X instructions
Important news
If you are a qualified business, failure to
submit Form M500 will result in removal
from the JOBZ program. You will also be
subject to repayment of prior JOBZ tax
benefits received.
This form is used to amend Form M500, reporting sales and use tax benefits you received
for participating in a Job Opportunity Building Zone (JOBZ).

Qualified business
You are a qualified business if your place of
business is located within a JOBZ zone and
you have signed a Business Subsidy Agreement with the zone administrator.

County and parcel ID number
Enter the county in which the qualified
business is located.
Enter the property’s primary parcel ID or
property ID number assigned to it by the
county. You can find the parcel or property
ID number on the property tax statement.
Attach a sheet with additional parcel numbers if more than one number is located
within the zone.

Email address
If the department has questions regarding
your Form M500 and you want to receive
correspondence electronically, be sure to
provide your email address.

Line instructions
Line 1

Check the appropriate box to indicate if you
received any tax benefits for participating in
a zone during the year you are amending.
If you did not receive any tax benefits, explain your situation, sign and file the form.

Lines 2–5

Complete lines 2 through 5 if you (or, in
some cases, your contractor) made purchases in the year you are amending that
were exempt from state and local sales taxes
for participating in a zone.

Line 2

Enter your purchases of taxable goods and
services that were primarily used or consumed in the zone during the year you are
amending.
Do not include:

Signature

An authorized representative of the qualified business must sign and date the form.

Where to file
Mail Form M500X to:

•	

purchases of capital equipment where
you have received, or expect to receive,
a refund of sales or use tax,

	
	
	

•	

purchases of motor vehicles or construction materials and supplies, or

or fax to: 651-556-3102

•	

product production purchases such as
raw materials and utilities. Materials
and utilities used or consumed in producing products for resale are already
exempt.

Use of information

Line 3

Enter the purchases made by you, or a contractor or subcontractor, of construction
materials and supplies used to construct
improvements to real property used by the
qualified business in the zone during the
year you are amending.
Ask your contractor for his or her purchasing information.

Line 4

A motor vehicle purchased by a qualified
business is exempt if the motor vehicle is
principally garaged in the zone and is primarily used as part of, or in direct support
of, the business’s operations carried on in
the zone.
Enter the Vehicle Identification Number
(VIN) and purchase price under line 4. If
more than four vehicles are used, complete
Form M500A, JOBZ Motor Vehicle Purchase
Report. Enter additional VINs/amounts of
purchase on the form and send with Form
M500.

Line 5

If the qualified business is located in an area
with a local sales and use tax, be sure to
enter the area on the line provided.
Visit our website for a listing of local tax
areas for the year you are amending.

Minnesota Revenue
Mail Station 9901
St. Paul, MN 55146-9901

All information provided on Form M500 is
nonpublic and cannot be disclosed to others
without your consent.
The information will be used to administer
the JOBZ program, however, and may be
shared with other state agencies, to the extent necessary to administer the JOBZ laws.

Questions or need forms?
You can find forms and the most current information on our website at
www.revenue.state.mn.us.
If you have questions, call 651-556-6836
during business hours. TTY users, call Minnesota Relay at 711.
We’ll provide information in other formats
upon request.