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Capital Gains Exemption for Technology Businesses

Certification Application for the Capital Gains Exemption

(Section 58.1322 of the Code of Virginia)

Name of Company:
FEIN:
Date of Formation:
Street Address:
City
State:
Zip Code:
Address of the above-named business’ principal office or facility:
 
Street Address:
City:
State:
Zip:
The above-named business is primarily engaged,
or is primarily organized to engage the following field:
 
advanced computing
advanced materials
advanced manufacturing
agricultural technologies
biotechnology
electronic device technology
energy
environmental technology
information technology
medical device technology
nanotechnology
other
Please describe the activity of the above-named business
and explain how it engages in the above field:
 
Declaration: I, the undersigned officer or other person authorized to act on behalf of the business entity, declare that all information included in this application is, to my knowledge, truthful.
 
Signature:
By typing my name
I understand I am submitting
a digital signature. 
Title:
Date:
Phone Number:
Fax Number:
Email:

Office of the Governor Robert F. McDonnell | © Commonwealth of Virginia 2012