Form 8874(K) Draft - Application For Certification Of Qualified Equity Investments Eligible For Kentucky New Markets Development Program Tax Credit - 2010 Page 2

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41A720-S80 (8874(K)) (6-10)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
Under penalties of perjury, I declare that the applicant’s allocation agreement remains in effect and has not been
revoked or canceled by the CDFI Fund; and that I have examined the application, including all accompanying
documents and statements, and to the best of my knowledge and belief, it is true, correct and complete.
By: ________________________________________________
____________________________________________________
Signature of executive offi cer of CDE
Date
Print Name: _______________________________________
Title: ______________________________________________
Department of Revenue Use Only
The application is approved __________
The application is not approved (see attached explanation) __________
By: ___________________________________________
Date: _____________________
Mail to Department of Revenue, Division of Corporation Tax, Station 52, 501 High Street, Frankfort, KY 40601-2103.
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