Form L - Request For Transfer
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1
2Missouri Development Finance Board
MISSOURI FORM
INFRASTRUCTURE DEVELOPMENT FUND TAX CREDIT
L
REQUEST FOR TRANSFER
The Missouri Form L must be used when transferring Infrastructure Development Fund Tax Credits. A separate Form L must be
submitted for each tax credit voucher being requested.
ASSIGNOR / Current Certificate Holder
Date
Name of Assignor(s)
Federal ID No. (FEIN)
Missouri Tax ID No.
Social Security Number(s)
Contact Person
Title
Address
City
State
ZIP Code
Telephone Number
Fax Number
E-mail
TRANSFER
Amount of Approved Tax Credit
Approved Tax Credit Number
Date of Contribution
Date of Transfer
$
Per RSMo Section 100.286 (7), credits may be sold for no less than seventy-five percent (75%) of the par value of such credits or an
amount not to exceed 100% of annual earned credits.
Amount of Tax Credits Sold
Discount Rate
Sale Price
$
%
$
$
Total Amount of Credit to be Transferred
CERTIFICATION
•
I certify that I am an authorized representative of the Assignor and as such am authorized to make the statement of affirmation
contained herein.
•
I certify under penalties of perjury, information contained in this document and attachments are complete, true, and correct to
the best of my knowledge and belief.
Assignor Signature(s)
Title
Print Name(s)
Date
NOTARY FOR ASSIGNOR
Appeared before me this ____ day of ___________________, 20___, __________________________________________ to me
personally known to be the person who executed the above certification, and acknowledged and states on his/her oath to me that he/she
executed the same for the purpose therein stated.
State of
County (or City of St. Louis)
Notary Public Printed Name
My Commission Expires
Notary Public Seal/Stamp
Notary Public Signature
RETURN
Mailing Address
UPS or Fed-Ex Overnight Address
Missouri Development Finance Board
Missouri Development Finance Board
COMPLETED
FORM TO:
P.O. Box 567
200 Madison Street, Suite 1000
Jefferson City, Missouri 65102
Jefferson City, Missouri 65101
Form L Page 1 of 2
Rev. 9/19/2011
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