Application for Corporate Income Tax and Insurance Premium Tax Credit
for Contributions to Nonprofit Scholarship Funding Organizations (SFOs)
(Under section 220.187 and 624.51055, Florida Statutes)
Business name ___________________________________________________________________________________________
Federal Employer Identification Number (FEIN)
Mailing address __________________________________________________________________________________________
City ___________________________________________ State _____________ ZIP __________________________________
Contact person ___________________________ Contact’s telephone number ____________________________________
Amount of planned contribution or previously approved credit you wish to carry forward to this tax year:
For taxable year beginning
Check here if the applicant is an insurance company
Insurance companies must claim the credit against Insurance Premium Tax imposed by section 624.509, F.S.
Choose one of the options below. You must complete a separate application for each SFO. Also, a separate
application is required for the total carry forward credit(s) that you wish to use for the tax year.
Contribution to SFO. Enter name as it appears on Florida Department of Education’s Internet site:
Credit carry forward
Do you give permission and grant authority to the Florida Department of Education to share the corporation’s name, address,
telephone number, and tax credit amount with the SFO identified in this application?
Type of federal tax return filed (check one) ❑ 1120 ❑ 1120A ❑ Other. Enter form number ______________________
If you file a consolidated Florida corporate income tax return, you must provide the parent corporation’s name and
Parent corporation’s FEIN
I hereby certify that I have examined this application form and the information contained here is, to the best of my
knowledge and belief, true, correct, and complete.
Signature of officer, owner, or partner