Commercial Form Alternative Fuel Vehicle Conversion And Infrastructure Credits
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Commercial Form
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Government of the
Alternative Fuel Vehicle Conversion and Infrastructure Credits
District of Columbia
This is a FILL-IN format. Please do not handwrite any data on this form other than your signature.
Please complete this form and return with the form D-20 or D-30 if claiming the credit.
A. Business information
Taxpayer ID
Business name
Claimant first name
M.I.
Last name
Social Security Number (SSN)
Telephone number
Email
Suite/Apt/Bldg
Mailing address
City
Zip code + 4
State
B. Alternative fuel vehicle (AFV) charging or fuel storage dispensing station
CLAIM 1
Equipment manufacturer
Invoice number
(B1) Equipment cost
(B2) Labor cost
(B3) Total cost (B1+B2)
(B4) Multiply B3 by 0.50
(B5) Credit amount not to exceed $10,000
per station or B4. (See instructions for limitations)
Installation address (no PO Boxes)
Suite/Apt/Bldg
City
State
Zip code +4
Hours of operation
Accepted payment methods
Access (Select one)
Public or
Private
CLAIM 2
Equipment manufacturer
Invoice number
(B1) Equipment cost
(B2) Labor cost
(B3) Total cost (B1+B2)
(B4) Multiply B3 by 0.50
(B5) Credit amount not to exceed $10,000
per station or B4. (See instructions for limitations)
Installation address (no PO Boxes)
Suite/Apt/Bldg
City
State
Zip code +4
Hours of operation
Accepted payment methods
Access (Select one)
Public or
Private
Commercial Form
l
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Revised 11/2014
Alternative Fuel Vehicle Conversion and Infrastructure Credits, Page 1
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Parent category: Financial