Form 315 - Notice Of Transfer Of Alaska Oil And Gas Production Tax Credit Certificate
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315
Notice of Transfer of Alaska Oil and Gas
Production Tax Credit Certificate under
AS 43.55.023 and 43.55.025
Federal EIN
Date
Taxpayer Name
Mailing Address
City
State
Zip Code
Contact Person for Examination of Records
Title
Contact Phone Number
Contact Fax Number
Contact Email Address
Production Tax Credit Certificate Number Transferred
Original Certificate Amount
Balance of Certificate (Before
Transfer)
Purchaser/Transferee Information
Federal EIN of Purchaser/Transferee
Name of Purchaser/Transferee
Mailing Address
City
State
Zip Code
Contact Person for Examination of Records
Title
Contact Email Address
Contact Phone Number
Contact Fax Number
Transfer Details
Date of Transfer
Nature of transfer (sale, exchange, other, etc.), attach signed copy of transfer document or sale agreement:
Amount received for sale or transfer of production tax credit certificate
Amount of tax credit transferred
Amount of tax credit retained by seller/transferrer
I declare under penalty of perjury that I am authorized to sign on behalf of the taxpayer this application and each attachment
has been examined by me and to the best of my knowledge and belief is true, correct and complete.
Signature
Date
Printed Name
Printed Title
This form is available online at
Submit completed forms via the Department’s Online
Tax Information System (OTIS) at .
Retain a copy for your records
315
Mail to: Alaska Department Of Revenue, 550 W 7th Ave STE 500, Anchorage AK 99501-3555
0405-315 Rev 01/13 - page 1
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