Form 572 - Transfer Agreement For Income Tax, Rural Electric Cooperatives Tax, Or Insurance Premium Tax Credit

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572
State of Oklahoma
Transfer Agreement for Income Tax,
Revised July 2006
Rural Electric Cooperatives Tax, or Insurance Premium Tax Credit
(See back of form for a list of transferable credits and the statutory reference)
On this ______ day of __________________, 200___, the transferor identified below, for good and valuable
consideration, hereby sells, conveys and transfers to the transferee, also identified below, certain tax credits,
(“credits”) earned under the applicable Oklahoma Statute in the amount of $ ___________. The transferred
credits were originally allowed to the transferor in the tax year of __________ (allowed year). If tax credits
originally allowed to the transferor for more than one tax year are being transferred, attach a Tax Commission
acknowledgment of credits for each tax year. If the current transferor obtained the credits by prior transfer,
enclose a copy of the prior transfer agreement.
Credit
Type of Credit
Transferor
Name
Address
Taxpayer Identification Number
Transferee
Name
Address
Taxpayer Identification Number
The transferor hereby represents that it has neither claimed for its own behalf nor conveyed to any other
transferee the credits transferred by this agreement.
The parties agree that the transferor, on behalf of both parties, shall file a copy of this jointly executed
agreement within 30 days of the date of transfer with the Oklahoma Tax Commission . The transferee also
agrees that it shall file a copy of this agreement with the income tax return, rural electric cooperatives tax return
or insurance premium tax return on which it claims the transferred credits or if it subsequently transfers the
credits, that it will execute and file a similar agreement.
Effective on the date stated above, the transferor and transferee agree to the transfer of the credits as
described above.
Transferor...
Transferee...
By
By
Company
Company
Certificate of Mailing...
A copy of the agreement was filed by first class U. S. Mail on the ______ day of ________________,
200___, with proper postage thereon fully prepaid to the following:
Oklahoma Tax Commission
Audit Division: Corporate Income Tax
Attention: Tax Credit Transfer Agreement
P.O. Box 53403, Oklahoma City, OK 73152-3403
Signature

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