Required
Attachments for
Electronic Filing
Form
W-RA
2019
Wisconsin
Department of Revenue
I-041 (R. 11-19)
Refer to instructions on back.
Taxpayer Information
(
Use BLACK Ink Only
)
Attachments – Submit this form only if you electronically filed your return or homestead credit claim.
Do NOT submit this form if you are filing a paper return or homestead credit claim.
Your legal last name Legal rst name M.I. Your social security number
If joint return, spouse’s legal last name Spouse’s legal rst name M.I. Spouse’s social security number
Address (number and street) Apt. no. Daytime phone number
City or post oce State Zip code Email address
Legal name of estate, trust, partnership, or corporation FEIN
PAPER CLIP required attachments here
Check the applicable box(es) to identify the attachments.
Amended return filed on Form 1, 1NPR, or X‑NOL – Attach forms, documents and/or schedules that support the item(s)
changed, as needed.
Angel investment credit (Schedule VC) – Attach a copy of the new business venture certification form provided by the
Wisconsin Economic Development Corporation (WEDC) and the tax credit verification form issued by the WEDC. If credit
is from a pass‑through entity, attach a copy of your Schedule 5K‑1, 3K‑1, or 2K‑1 instead.
Business development credit (Schedule BD) – Attach a copy of the certification form and the tax credit verification from
WEDC. If credit is from a pass‑through entity, attach a copy of your Schedule 5K‑1, 3K‑1, or 2K‑1 instead.
Community rehabilitation program credit (Schedule CM) – Attach signed Part II of Schedule CM. If credit is from a pass‑
through entity, attach a copy of your Schedule 5K‑1, 3K‑1, or 2K‑1 instead.
Development zones credit (Schedule DC) – Attach a copy of your certification to claim tax benefits and the verification of
expenses from WEDC. Also attach a statement from WEDC verifying the amount of credit for environmental remediation and
job creation or retention. If credit is from a pass‑through entity, attach a copy of your Schedule 5K‑1, 3K‑1, or 2K‑1 instead.
Early stage seed investment credit (Schedule VC) – Attach a copy of the certification issued by WEDC to the business
and to the fund manager and a statement from the fund manager containing (1) name and address of the fund manager
and (2) for each investment, the date, total amount of investment, amount invested in a qualified new business venture,
and amount of tax credit. If credit is from a pass‑through entity, attach a copy of your Schedule 5K‑1, 3K‑1, or 2K‑1 instead.
Economic development credit (Schedule ED) – Attach a copy of your certification and the notice of eligibility to receive tax
benefits from the WEDC. If credit is from a pass‑through entity, attach a copy of your Schedule 5K‑1, 3K‑1, or 2K‑1 instead.
Electronics and Information Technology Manufacturing Zone Credit (Schedule EIT) – Attach a copy of your tax benefit certifi-
cation issued by the WEDC. If credit is from a pass‑through entity, attach a copy of your Schedule 5K‑1, 3K‑1, or 2K‑1 instead.
Eligible veterans and surviving spouses property tax credit – Attach real estate tax bill(s) for all taxes paid in 2019,
proof of payment, your Wisconsin Department of Veterans Affairs certification, if required, and any other documentation
requested in the instructions.
Employee college savings account contribution credit (Schedule ES) – If credit is from a pass‑through entity, attach a copy
of your Schedule 5K‑1, 3K‑1, or 2K‑1.
Enterprise zone jobs credit (Schedule EC) – Attach a copy of your certification to claim tax benefits and the verification of
your expenses from WEDC. If credit is from a pass‑through entity, attach a copy of your Schedule 5K‑1, 3K‑1, or 2K‑1 instead.
Farmland preservation credit (Schedule FC or FC‑A) – See the instructions for the schedule you are filing for the required
attachments.
Historic rehabilitation credit (Schedule HR) – See Schedule HR for the required attachments.
Homestead credit (Schedule H or H‑EZ) – Attach required documents (W‑2s, W‑2Gs, 1099‑Rs, 1098‑Ts, original rent
certificate(s), tax bill(s), legal documents, and statements). Attach a copy of Schedule GL if using electronic software that
does not submit the Schedule GL as part of the electronic return.
Jobs tax credit (Schedule JT) – Attach a copy of your certification to claim tax benefits issued by WEDC and the notice of
eligibility to receive tax benefits that reports the amount of tax benefit from WEDC. If credit is from a pass‑through entity,
attach a copy of your Schedule 5K‑1, 3K‑1, or 2K‑1 instead.
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