Form 527 - Small Business Capital Company Information Report - 2004
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1527
Oklahoma Tax Commission
Small Business Capital Company
Revised 2004
Information Report
For the Calendar Year Ending:
Identification Number
Corporation
Partnership
LLC
Name of Small Business Capital Company
Address
City
State
Zip
Complete the applicable sections for investments made during this calendar year.
Attach additional schedules if necessary.
A
Entities Investing in the Small Business Capital Company
Amount
Date of
Identification
Investor’s Name
Address
Investment
Invested
Number
/
/
1)
/
/
2)
/
/
3)
/
/
4)
/
/
5)
/
/
6)
B
/
/
Entities Investing in Oklahoma Small Business Ventures
in Conjunction with the Small Business Capital Company
/
/
Identification
Business
Identification
Date of
Amount
Investor’s Name
Number
Invested In
Number
Investment
Invested
1)
/
/
/
/
2)
3)
/
/
4)
/
/
C
Oklahoma Small Business Ventures in which Investments Were Made
by the Small Business Capital Company
Identification
Date of
Amount
Type of Business
Name of Business Invested In
Number
Investment
Invested
/
/
1)
2)
/
/
3)
/
/
4)
/
/
Under penalties of perjury, I declare that I have examined this return, including accompanying statements, and to the best of my
knowledge and belief it is true, accurate and correct.
Officer, General Partner or Member
Date
The Oklahoma Tax Commission is not required to give actual notice to taxpayer of changes in any state tax law.
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