Form Mo-Tf - Missouri Transfer
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1MO-TF
MISSOURI TRANSFER
Form MO-TF should be used for all tax credit transfers authorized by the Missouri Department of Economic Development.
IMPORTANT. You must submit a separate Form for each tax credit certificate being requested. PLEASE TYPE OR PRINT.
FOR CALENDAR YEAR _______ OR TAX YEAR BEGINNING _________________________ , ENDING _________________________ .
SECTION 1
NAME OF TAXPAYER
DATE
A
S
ADDRESS (STREET, P.O. BOX)
CITY
STATE
ZIP CODE
S
I
SPOKESPERSON (NAME AND TITLE)
TELEPHONE NUMBER
G
N
F.E.I.N OR S.S. NUMBER
MO TAX I.D. NUMBER
O
R
APPROVED BENEFIT NUMBER
DATE INVESTMENT OR CONTRIBUTION WAS MADE
SECTION 2
TAX PERIOD
FOR CALENDAR YEAR _______ OR TAX YEAR BEGINNING ______________________ , ENDING _______________________
NAME OF ASSIGNEE
ADDRESS OF ASSIGNEE (STREET/P.O. BOX)
CITY
STATE
ZIP CODE
TELEPHONE NUMBER OF ASSIGNEE
F.E.I.N. OR S.S. NUMBER
MO TAX I.D. NUMBER
A
ORGANIZATION TYPE
S
CORPORATION
FIDUCIARY
INDIVIDUAL PROP.
OTHER
S
NOT FOR PROFIT
PARTNERSHIP
INDIVIDUAL
S-CORP.
I
NOTE: If the taxpayer is a fiduciary, partnership or S-Corporation, a separate sheet to this application must be attached which
G
identifies the names, social security numbers and proportioned share of each beneficiary, partner or shareholder. Aggregate
N
proportionate shares or percent of total ownership may not exceed 100%.
E
TOTAL AMOUNT OF TAX CREDIT TO BE TRANSFERRED
$
E
IF TAX CREDITS TRANSFERRED ARE BEING SOLD TO THE ASSIGNEE, ENTER THE PERCENT OF PAR VALUE FOR WHICH
SUCH CREDITS ARE BEING SOLD.
@
AMOUNT CREDIT SOLD
% OF PAR VALUE EQUALS
SALE PRICE
$
@
$
$
@
$
@
$
$
SECTION 3
Under penalty of perjury, we declare that we have examined this form, and to the best of our knowledge and belief, it is true, correct and
complete. We do hereby affix our signatures hereto on this ____________________ day of ____________________ , __________.
ASSIGNOR
❿
MUST BE SIGNED IN
PRESENCE OF NOTARY
ASSIGNEE
❿
NOTARY PUBLIC EMBOSSER OR
STATE
COUNTY (OR CITY OF ST. LOUIS)
BLACK INK RUBBER STAMP SEAL
SUBSCRIBED AND SWORN BEFORE ME, THIS
DAY OF
YEAR
USE RUBBER STAMP IN CLEAR AREA BELOW.
NOTARY PUBLIC SIGNATURE
MY COMMISSION
EXPIRES
NOTARY PUBLIC NAME (TYPED OR PRINTED)
MO 419-2728 (2-03)
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