Form Clt-4 - Corporation License Tax Return

Form Clt-4 - Corporation License Tax Return - 2004 Page 4

Schedule C

FEIN

Year

Type of Credit

Amount of Credit

Montana Capital Company Credit

New/Expanded Industry Credit

Interest Differential Credit

Montana Dependent Care Assistance Credit ............attach Form DCAC

Montana College Contribution Credit ..............................attach Form CC

Health Insurance for Uninsured Montanans Credit ...........attach Form HI

Montana Recycle Credit ............................................ attach Form RCYL

Alternative Energy Production Credit .........................attach Form AEPC

Contractor’s Gross Receipts Tax Credit ......attach supporting schedule

10. Alternative Fuel Credit ................................................attach Form AFCR

11. Infrastructure Users Fee Credit

12. Qualified Endowment Credit ........................................attach Form QEC

13. Historical Buildings Preservation Credit .........attach Federal Form 3468

14. Increase Research and Development Activities Credit .......attach Form RSCH

15. Mineral Exploration Incentive Credit ......................attach Form MINE-CERT

16. Affordable Housing Revolving Loan Account Contributions Credit

17. Developmental Disability Account Contribution Credit

18. Empowerment Zone Credit

Total Credits (enter here and on line 12 of the CLT-4)

To receive these credits, the prescribed corporation tax forms or a detailed schedule must be

attached with this schedule to the CLT-4.

Send completed Montana corporation license tax returns to the following address:

Montana Department of Revenue

PO Box 8021

Helena, MT 59604-8021

Form Clt-4 - Corporation License Tax Return - 2004 Page 4