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VC
Wisconsin Venture Capital Credits
Schedule
2005
Attach to Wisconsin Form 1, 1NPR, 2, 3, 4, 4I, 4T, 5, or 5S
Wisconsin Department of
Read instructions before filling in this schedule
Revenue
Name
Identifying Number
Part I Angel Investment Credit
1
Fill in the following information regarding your investments in qualified new business ventures
that the Department of Commerce has verified as eligible for a tax credit in 2005 (attach
separate schedules if more space is needed):
Date
Name and Address
Total
Qualified
Investment
of Qualified
Investment
Investment
Made
New Business Venture
a
b
c
d
e
Total qualified investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2
Multiply the amount on line 1 by 12.5% (0.125) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3
Fill in the 2005 angel investment credit passed through from angel networks . . . . . . . . . . . . 3
4
Add lines 2 and 3. This is the total 2005 angel investment credit . . . . . . . . . . . . . . . . . . . . . . 4
Part II Early Stage Seed Investment Credit
5
Fill in the following information regarding your investments paid to a certified fund
manager that the Department of Commerce has verified as eligible for a tax credit in
2005 (attach separate schedules if more space is needed):
Date
Name and Address
Total
Qualified
Investment
of Certified Fund
Investment
Investment
Made
Manager
a
b
c
d
e
Total qualified investment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6
Multiply line 5 by 25% (0.25) or enter the credit specially allocated to you . . . . . . . . . . . . . . . 6
7
Fill in the 2005 early stage seed investment credit passed through from other
entities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8
Add lines 6 and 7. This is the total 2005 early stage seed investment credit . . . . . . . . . . . . . 8
IC-039