Form Fiia-09 - Application For Transfer Or Sale Of Tax Credit Form (Page 2 of 2) in pdf

Form Fiia-09 - Application For Transfer Or Sale Of Tax Credit Form Page 2

W V FO - Form FIIA-09: Application for Transfer or Sale of Tax Credit

Page 2 of 2

TA X RE TURN FILING

Claims of the credit to offset West Virginia taxes (i.e., Business Franchise Tax, Corporation Net Income Tax and/or Personal Income Tax) require a

completed West Virginia State Tax Department Schedule FIIA-TCS (available at ) to be filed with the appropriate

West Virginia tax returns or amended returns, along with any other required support documentation, including the original Tax Credit Voucher(s)

(copies not acceptable).

SIGNATURE AND VERIFICATION

The undersigned is electing to make a transfer or sale of a tax credit under the WV Film Industry Investment Act and

is applying to the West Virginia Film Office for approval. Under penalties of perjury, I declare that I have examined

this application, including all accompanying documentation, and to the best of my knowledge and belief, it is true,

correct and complete. I further declare that I have read the rules and regulations of the WV Film Industry Investment

Act. I understand that this application and accompanying documentation are subject to committee review and

verification before a transfer or sale may occur.

Authorized Signature ________________________________________________________________

Title ______________________________________________ Date _________________________

PRINT Name _______________________________________________________________________

Phone

__________________________________________________________

(if different than above)

CHECKLIST FOR APPLICATION

The following documentation must accompany application:

Original Tax Credit Voucher(s)

Certificate of Good Standing from the WV State Tax Department for Transferor/Seller (form available at )

SUBMIT TING APPLICATION

Deliver one original of completed application and support documentation to:

West Virginia Film Office

AT TN: Film Credit Development Committee

90 MacCorkle Avenue, SW

South Charleston, W V 25303

Department Use Only

Date/Time Rec. ____________________________

Received By _______________________________

Eligibility Application #

__________________________________________

Modification Application #

(if applicable)

__________________________________________

West Virginia Film Office 90 MacCorkle Avenue, SW • South Charleston, WV 25303 • 866-698-3456 •

Form FIIA-09

9/17/12

Form Fiia-09 - Application For Transfer Or Sale Of Tax Credit Form Page 2