Form 1811cc 0701 - Certification Of Unused Delaware Historic Preservation Tax Credits - 2010

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2010
STATE OF DELAWARE
STATE OF DELAWARE
OFFICE OF THE STATE BANK COMMISSIONER
DIVISION OF REVENUE
FORM 1811CC 0701
555 E. LOOCKERMAN ST.
820 North French St.
CERTIFICATION OF UNUSED DELAWARE
DOVER. DE 19901
P.O. Box 8911
HISTORIC PRESERVATION TAX CREDITS
Wilm., DE 19899-8911
PART A - NAME AND ADDRESS OF CURRENT QUALIFIED PROPERTY OWNER
1. Enter Federal Employer Identification Number or Social Security Number:
2. Name of Current Qualified Property Owner
3. Address
4. Location of Qualifying Historic Property (If different from above)
/
/
/
/
5. Qualifying Dates
Stage II Approval:
Certificate of Completion Issued:
PART B - NAME AND ADDRESS OF CREDIT PURCHASER/TRANSFEREE/ASSIGNEE
1. Enter Federal Employer Identification Number or Social Security Number:
2. Name of Credit Purchaser/Transferee/Assignee
3. Address
The undersigned, on behalf of the qualified property owner, agrees to the release of information pertaining to the Delaware Historic Preservation
Tax Credits for the historic property identified above to the Credit Purchaser/Transferee/Assignee identified above for the purpose of certifying
the amount of Delaware Historic Preservation Tax Credits to be claimed by the Credit Purchaser/Transferee/Assignee.
NAME
TITLE
DATE
STOP: Only complete Part A and Part B of this form. Part C of this form will be completed and certified by the
Delaware Division of Revenue and the Delaware State Bank Commissioner Office.
PART C - CERTIFICATION OF THE HISTORIC PRESERVATION TAX CREDIT
/
/
/
/
Current Qualified Property Owner:
Initial Tax Year To Claim Credits:
Tax Year In Which Credits Expire:
/
/
/
/
Credit Purchaser/Transferee/Assignee: Initial Tax Year To Claim Credits:
Tax Year In Which Credits Expire:
1.
Total Delaware Historic Preservation Tax Credits granted
$
2.
Delaware Historic Preservation Tax Credits previously claimed against Title 30 income taxes
$
3.
Delaware Historic Preservation Tax Credits previously claimed against Title 5 bank franchise taxes
$
4.
Subtotal. Add Line 2 and Line 3
$
Certified Unused Delaware Historic Preservation Credits
5.
(Subtract Line 4 from Line 1)
$
The Delaware Division of Revenue and the Office of the State Bank Commissioner hereby certifies that the above listed credits and tax year
ending dates are true, correct and complete.
NAME
DIVISION OF REVENUE TITLE
DATE
NAME
STATE BANK COMMISSIONER TITLE
DATE
Revised 12/09/10

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