Form F-1193t - Notice Of Intent To Transfer A Florida Energy Tax Credit

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F-1193T
Florida Department of Revenue
R. 07/12
Notice of Intent to Transfer a Florida Energy Tax Credit
Rule 12C-1.051
Corporate Income Tax
Florida Administrative Code
Sections 220.191(2)(c), 220.192(6), or 220.193(3)(f), Florida Statutes
Transferor Information
Indicate the credit to be transferred:
220.191(2)(c)
220.192
220.193
Transferor's Name: ________________________________________________________________________________________
–
Federal Employer Identification Number (FEIN):
Business Address: ________________________________________________________________________________________
City: _____________________________________________________ State: _______ ZIP Code: _______________________
Contact Name: ____________________ Telephone Number: __________________E-Mail Address: _____________________
The taxable year the credit was originally approved for:
Beginning Date: _______ Ending Date: ________
Original amount of credit allocated or transferred to the transferor: $ ____________________________________________
Amount of original credit (listed above) previously claimed or transferred: $ ______________________________________
Tax year(s) in which the credit amount above was claimed or transferred: ________________________________________
Amount of unused credit: $ ____________________________________
Amount of credit to be transferred: $ ____________________________
Transferor Consolidated Return Filing Information
If the transferor is included in a consolidated Florida corporate income tax return, please provide:
–
Parent corporation name ___________________________________ Parent FEIN:
Transferee Information
(A separate notice is required for each transferee.)
Taxpayer (Corporation or Business Name): ___________________________________________________________________
–
Federal Employer Identification Number (FEIN):
Business Address: ________________________________________________________________________________________
City: _____________________________________________________ State: _______ ZIP Code: _______________________
Contact Name: ____________________ Telephone Number: __________________E-Mail Address: _____________________
Transferee’s Tax Year: Beginning: _________ Ending: _________
Transferee Consolidated Return Filing Information
If the transferee is included in a consolidated Florida corporate income tax return, please provide:
–
Parent corporation name ___________________________________ Parent FEIN:
Transferor's Certification
I certify that the foregoing has been examined by me and the information contained herein is, to the best of my
knowledge and belief, true, correct and complete.
______________________________________________________
____________________________________
Signature of officer of transferor and title
Date

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