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Qualified Connecticut Business Recertification for Angel Tax Credit Program
Does the company have gross revenues of under $1 million?
(Required)
Yes
No
Indicate revenue
(Required)
Does the company have fewer than 25 employees (including shareholders, members or partners active in company operations)?
(Required)
Yes
No
Number of employees
(Required)
Does the company have at least 75% of total number of employees residing in Connecticut?
(Required)
Yes
No
Percentage of employees
(Required)
Has the company been in operation in Connecticut for less than seven consecutive years?
(Required)
Yes
No
Date company was established
(Required)
Is the company primarily owned by the management team of the business and/or their families?
(Required)
Yes
No
You do not qualify for this program.
Company Info
Legal company name
(Required)
Trade name/DBA
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Is this address the company’s headquarters or principal place of business?
(Required)
Yes
No
Contact name
(Required)
First
Last
Contact title
(Required)
Contact email
(Required)
Contact phone
(Required)
Company Federal Tax ID
(Required)
Connecticut Tax Registration Number
SIC or NAICS
List addresses of additional company locations (if applicable)
Add
Remove
Qualifying Business Activities
Are you still engaged in a qualifying business activity?
(Required)
Choose Y/N
Y
N
Choose your qualifying business activity
(Required)
"Bioscience" means manufacturing pharmaceuticals, medicines, medical equipment or medical devices and analytical laboratory instruments, operating medical or diagnostic testing laboratories, or conducting pure research and development in life sciences.
"Advanced materials" means developing, formulating or manufacturing advanced alloys, coatings, lubricants, refrigerants, surfactants, emulsifiers or substrates
"Photonics" means generation, emission, transmission, modulation, signal processing, switching, amplification, detection and sensing of light from ultraviolet to infrared and the manufacture, research or development of opto-electronic devices, including, but not limited to, lasers, masers, fiber optic devices, quantum devices, holographic devices and related technologies.
"Information technology" means software publishing, motion picture and video production, tele production and postproduction services, telecommunications, data processing, hosting and related services, custom computer programming services, computer system design, computer facilities management services, other computer related services and computer training.
"Clean technology" means the production, manufacture, design, research or development of clean energy, green buildings, smart grid, high-efficiency transportation vehicles and alternative fuels, environmental products, environmental remediation and pollution prevention.
Other
Investment sought and qualified securities to be issued
Total amount of cash investments sought from Angel Investor
(Required)
Must be less than or equal to $2 million.
Type of qualified security to be issued (check all that apply)
(Required)
General Partnership Interest
Limited Partnership Interest
Common Stock
Preferred Stock (must be convertible to common stock)
Other form of equity
Please describe any other forms of equity
(Required)
REQUIRED DOCUMENT UPLOAD SECTION
An updated schedule of the current equity holders of the company listing the name of the equity holder, the percentage of total equity owned and the equity holder’s relationship to the company
(Required)
Max. file size: 50 MB.
An updated schedule of the names and addresses of all company employees.
(Required)
Max. file size: 50 MB.
A copy of the company’s income tax return for its most recent fiscal year.
(Required)
Max. file size: 50 MB.
CERTIFICATION STATEMENT
I agree.
THE APPLICANT:
1. Certifies that to the best of its knowledge and belief, the information being submitted to CI is true and correct.
2. Certifies that the applicant is in compliance with all laws, regulations, ordinances and orders of public authorities applicable to it.
3. Certifies that the applicant is not in default under the terms and conditions of any grant or loan agreements, leases, or financing agreements with its creditors.
4. Agrees to include in its private placement memorandum or equivalent documents substantially the following statement:
“The approval of the company’s application, the listing of the company by Connecticut Innovations, Incorporated (“CI”) as qualified to receive cash investments eligible for a Connecticut income tax credit, and/or the use of the phrase “Qualified Connecticut Business” do not constitute the endorsement or recommendation by CI or the State of Connecticut of an investment in the securities of the company. Neither CI nor the State of Connecticut has made or is making any representations or warranty of any kind with respect to the value of the company’s securities, the financial condition or future earnings of the company, the management of the company, or the company’s business or prospects. In no event shall CI or the State of Connecticut have any responsibility for any investment losses or other damages that may be suffered as a result of an investment in the company.”
5. Acknowledges that designation as a “Qualified Connecticut Business” does not result in any exemption from state and federal securities laws and agrees to comply with all requirements of such laws applicable to applicant and its offer and sale of securities.
6. Understands that CI is a “public agency” for purposes of the Connecticut Freedom of Information Act (“FOIA”). Accordingly, upon receipt at the office of CI, any application under the Connecticut Angel Investor Tax Credit Program will be considered a public record or file subject to disclosure under the FOIA. The FOIA includes exemptions for “trade secrets” and “commercial or financial information given in confidence, not required by statute.” In addition, all financial and credit information and all trade secrets contained in an application for financial assistance or obtained by CI concerning any applicant for financial assistance or any project, activity, technology, product or invention is exempt from disclosure under FOIA.
Only the particular information falling within one of these exemptions can be withheld by CI if made the subject of a public records request under FOIA. Therefore, an applicant under the Connecticut Angel Investor Tax Credit Program should specifically identify those particular sentences, paragraphs, pages, sections or exhibits that it claims to be exempt.
Applicants should be aware that (i) CI has no obligation to notify any applicant of any FOIA request received by CI; (ii) CI may disclose materials claimed to be exempt if in its judgment such materials do not appear to fall within a FOIA exemption; (iii) CI may in its discretion notify applicants of FOIA requests and/or of complaints made to the Freedom of Information Commission concerning items for which an exemption has been claimed, but CI has no obligation to initiate, prosecute or defend any legal proceeding or to seek to secure any protective order or other relief to prevent disclosure of any information pursuant to an FOIA request, (iv) the applicant will have the burden of establishing the availability of any FOIA exemption in any such legal proceeding, and (v) in no event shall CI or any of its officers, directors or employees have any liability for disclosure of documents or information in the possession of CI which CI, or such officer, director or employee, in good faith believes to be required pursuant to the FOIA or other requirements of law.
In the event of a public records request for an application under the Connecticut Angel Investor Tax Credit Program, CI may request, and each applicant agrees promptly to provide to CI, a version of such application from which all information for which an FOIA exemption has been claimed has been redacted.
Except for trade secret or other proprietary information identified as such pursuant to the section above dealing with the Freedom of Information Act, CI is not restricted in its right to use or disclose any or all of the information contained in any application and can do so without compensation to the applicant, notwithstanding any language in the application to the contrary.
Signature
A $250 non refundable application fee payable by check to CI is due upon approval. Connecticut Innovations Angel Tax Credit 470 James Street Ste 8 New Haven CT 06513
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