Form Mdcc - Medical Device Credit Certificate 2006 - Massachusetts Department Of Revenue

2006

Massachusetts

Form MDCC

Department of

Medical Device Credit Certificate

Revenue

For calendar year 2006 or taxable year beginning

and ending

Medical device company name

Federal Identification or Social Security number

Street address

City/Town

State

Zip

Name of contact person

Telephone number

E-mail address

1 Type of medical device company:

Corporation

Trust

Partnership

Sole proprietorship

LLC

Other

2 Tax year in which user fees were paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Certificate number issued by Massachusetts Department of Revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Amount of medical device credit eligible for use or transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

No Carryover

Credits may not be carried over by a medical device company to other taxable years.

Transfer or Sale Information

A medical device company wishing to transfer any amount of the medical device credit in line 4 above must first complete and file with the Department of

Revenue, at the address below, a Medical Device Credit Transfer Application, Form MDCTA.

Department of Revenue Filing

All credit information should be mailed to: Massachusetts Department, Audit Division, 200 Arlington Street, Room 4300, Chelsea, MA 02150, attn:

Medical Device Unit.