Form 3614 - Michigan Historic Preservation Tax Credit Assignment - 2001
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1
2Michigan Department of Treasury, SBT
3614 (Rev. 10-01)
MICHIGAN HISTORIC PRESERVATION TAX CREDIT ASSIGNMENT
Part 1: Assignor Identification
1. Assignor Name
2. Tax Year End
3. Account No. (FEIN or TR No.)
Street Address
4. Project Number
5. Date Project was Certified as Completed
6. Organization Type (check one)
City, State, ZIP
Partnership/LLC-Partnership
Limited Liability Company-Corporation
S-Corporation
7. Indicate the Method Used to Assign the Credit
Alternative Method (attach details)
% of Ownership
Part 2: Credit Calculation
8.
State Equalized Value (SEV) ......................................... 8. ____________________
.00
9.
Qualified Expenditures .................................................................................................... 9. _____________________
.00
10.
Multiply line 9 by 25% (.25) ............................................................................................. 10. _____________________
.00
11.
Enter the total amount of credit claimed on U.S. 3468, Investment Credit, line 1c ....... 11. _____________________
.00
12.
Michigan Historic Preservation Tax Credit. Subtract line 11 from line 10 ....................... 12. _____________________
.00
Part 3: Assigning the Credit (see back of form for more space)
A.
B.
C.
D.
E.
Assigned Credit
(multiply line 12 by
Assignee
Date
% of Credit
Column D. Enter here
Account Number
Assignee
Assignee's Tax
to be
and on form 3581,
(FEIN, TR or SSN)
Name
Year Ends
Assigned
line 8, for each assignee)
(Assignor)
a.
b.
c.
d.
e.
f.
g.
h.
I certify that the information provided on this return is accurate and that the
100%
assignees agree that the assigned credit is the amount to be claimed on their
individual or single business tax return.
Assignor's Signature ____________________________________________
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