Indiana State Form 51300 - Application For Historic Rehabilitation Tax Credit Certification

Download a blank fillable Indiana State Form 51300 - Application For Historic Rehabilitation Tax Credit Certification in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Indiana State Form 51300 - Application For Historic Rehabilitation Tax Credit Certification with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Reset Form

APPLICATION FOR HISTORIC

Division of Historic Preservation and Archaeology

REHABILITATION TAX CREDIT CERTIFICATION

402 W. Washington St., W274, Indianapolis, IN 46204-2739

317-232-1646; FAX 317-232-0693; dhpa@dnr.in.gov

State Form 51300 (R / 4-14)

Instructions:

1. Read all instructions before completing application.

2. Please type or print clearly in black ink.

FOR OFFICE USE ONLY

3. Certification cannot be made unless a completed application form has been received.

Project No.

4. If additional space is required, please attach additional sheets.

NOTE: A copy of this form will be provided to the Indiana Department of Revenue.

BOX #1

PROGRAM REQUEST

This application seeks certification for rehabilitation tax credits under the (check one) :

State program only.

State & Federal programs.

BOX #2

PROPERTY INFORMATION

Property Name

Property Address (Number and Street)

City

County

ZIP Code

BOX #3

PROPERTY SIGNIFICANCE

Date Listed

Property is listed individually on the Indiana Register of Historic Sites and Structures.

(month, day, year)

Historical name of property:

Property is located within a historic district listed in the Indiana Register of Historic Sites and Structures.

Name of Historic District:

BOX #4

BUILDING AND PROJECT DATA

Date Building Constructed:______________________________

Type of Construction:

Number of square feet on ground floor before rehabilitation:____________

Check here to indicate that documentation

is attached showing that the structure is at

Check here to indicate that drawings of current

least 50 years old.

t 50

ground floor plan, including dimensions, is

d fl

l di

Use(s) before rehabilitation:___________________________

attached.

Proposed use(s) after rehabilitation:______________________

Number of square feet on ground floor after rehabilitation:____________

Estimated cost of qualified rehabilitation expenditures

(Must be at least $10,000) _____________________________

Check here to indicate that drawings of proposed

Check here if this project is to be completed

ground floor plan, including dimensions, is

in phases.

attached.

This application covers phase _____ of _____ phases.

Project/phase start date (est.):____________________

Total area before rehabilitation:__________

Completion date (est.):______________________

Total area after rehabilitation:__________

BOX #5

PROJECT CONTACT

Name

Daytime Telephone Number

Address (Number and Street)

City

County

State

ZIP Code

E-mail Address (optional)

BOX #6

PROPERTY OWNER

I affirm under the penalty for perjury that the information I have provided is, to the best of my knowledge, correct and that I own the property described above.

Name of Signator

Organization/Company

Address (Number and Street)

Daytime Telephone Number

City

County

State

ZIP Code

E-mail Address (optional)

Social Security Number or Tax Identification Number

Owner Signature

Date (month, day, year)