Qualified Fund Annual Report Form
Download a blank fillable Qualified Fund Annual Report Form 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 Qualified Fund Annual Report Form 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.
ADVERTISEMENT
1
2Minnesota Department of Employment and Economic Development
Angel Tax Credit Program
Qualified Fund Annual Report
Due February 1st
Data Privacy Notice:
per Minn. Stat. 116J.8737, Subd. 8, data provided in this report is not public data; certain information
became public upon certification as a qualified investor and upon a credit allocation and will become public upon a credit
revocation. Qualified investor’s names are posted on the department’s website.
Tennessen Warning Notice:
per Minn. Stat. 13.04, Subd. 2, this data is being requested from you to determine if you may
retain the tax credits you received under the Angel Tax Credit Program. You are not required to provide the requested
information, but failure to do so will result in the department’s revocation of the tax credit certificate you received. Upon
revocation of tax credits under the Angel Tax Credit Program, this information will be shared with the Minnesota Department of
Revenue.
Reporting Requirements:
Qualified funds must submit an annual report for three years for
investments for which an angel tax credit was received by the fund’s investors; three years includes the
year the investment was made and the two following years. Example, an investment made in 2015
requires an Annual report to be submitted for the 2015, 2016, and 2017 calendar years.
Annual report for calendar year: ______________
Section I.
NAME AND IDENTIFYING INFORMATION
Name (“Fund”): _________________________________________________ FEIN: ____-____________
Fund Contact Name: First:
M.I.:__Last:
Title: __________________________________
Street Address 1: _____________________________________________________________________
Street Address 2: ___________________________ City: ____________________________________
County: _____________________________________ State: ___________ Zip: _________________
Phone: __________________________________ Email Address: _______________________________
Has any of the above information changed since your last filing?
Yes
No
Section II.
ANGEL TAX CREDIT INVESTMENTS
A.
Angel tax credit investments held by the fund as of December 31
List each qualified investment made by the fund for which angel tax credits were (or will be)
received by the fund’s members:
NOTE: Do not list investments for which the three year holding period has passed.
Date of
Name of business invested in
Original amount of investment
investment
MN DEED
Qualified Fund
Angel Tax Credit Program
1
2015 Annual Report Form
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Car - Cemetery Permanent Maintenance And Merchandise Trust Funds Annual Report Form - Secretary Of State
Legal
Form Ar 50 - For-profit Corporation Annual Report, Form Ag - Annual Report Agriculture Attachment For Ar Or Np Forms - 2007
Legal
Form Np 50 - Not-for-profit Corporation Annual Report, Form Ag - Annual Report Agriculture Attachment For Ar Or Np Forms
Legal
Form Hud-40201 - Youthbuild Program Reports Part 11 Sources Of Funds (final Report) Form - U.s. Department Of Housing And Urban Development
Legal
Related Categories
Parent category: Financial