Fillable Form L - Request For Transfer (Page 2 of 2) in pdf

Form L - Request For Transfer Page 2

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Missouri Development Finance Board

MISSOURI FORM

INFRASTRUCTURE DEVELOPMENT FUND TAX CREDIT

REQUEST FOR TRANSFER

ASSIGNEE / New Certificate Holder

Name of Assignee(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

ASSIGNEE/TAXPAYER TYPE (check one)

Corporation

Fiduciary

Individual Proprietorship

Partnership

S-Corporation

Individual

Issued for Calendar Year

or Tax Year Beginning

Ending

If the taxpayer is a Fiduciary, Partnership, or S-Corporation, or other entity with a flow through tax treatment, identify the names, social

security numbers, and proportionate share of ownership of each beneficiary, partner, or shareholder. The aggregate proportionate shares

or percent of total ownership may not exceed 100%. Attach a separate sheet if necessary.

Name(s)

Social Security Numbers

% Ownership Year End

The taxpayer acquiring credits (the assignee), may use the acquired credits to offset up to 100% of the tax liabilities otherwise imposed by RSMO

Chapter 143, excluding withholding tax imposed by Sections 143.191 to 143.261, RSMo Chapter 147, or RSMo Chapter 148. Per RSMo 100.286 (7),

notwithstanding any other provision of law to the contrary, the amount received by the assignor such credit shall be taxable as income of the assignor,

and the excess of the par value of such credit above the price paid shall be taxable as income of the assignee. These credits cannot be used to amend a

previously filed return by the original contributor or any subsequent assignee for any tax year beyond the immediately preceding tax year, if that return

has not yet been filed, in which the credit was acquired.

CERTIFICATION

•

I certify that I am an authorized representative of the Assignee 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.

Assignee Signature(s)

Title

Print Name(s)

Date