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STATE OF DELAWARE

D IV ISIO N O F REV EN U E

APPLICATION AND COMPUTATION SCHEDULE FOR CLAIMING

8 2 0 N o rt h F re n ch St .

FORM 1801AC 0009

P .O . Bo x 8763

DELAWARE LAND & HISTORIC RESOURCE CONSERVATION TAX CREDITS

W ilm

19899- 8763

FORM 1801AC MUST BE COMPLETED AND SUBMITTED ON OR BEFORE JANUARY 31ST AFTER THE END OF THE CALENDAR

YEAR DURING WHICH THE QUALIFIED LAND WAS CONVEYED TO A QUALIFIED CONSERVATION AGENCY.

PART A - NAME AND ADDRESS OF APPLICANT

Tax Period Ending Date

1. Enter Federal Employer Identification Number

Social Security Number

1 ---

2 ---

2. Type of Entity:

SCorporation

Partnership

Individual/Sole Proprietor

CCorporation

Decedent Estate

Other Pass-Through Entity:

Estate/Trust

(Enter type of entity)

3. Name of Applicant

4. Address

State

Zip

City

Delaware Address

(If different from above)

City

State

Zip

6. Contact Person

Telephone Number

E-mail Address

FaxNumber

PARTB – DELAWARELAND &HISTORICRESOURCECONSERVATION TAXCREDITCOMPUTATION

Fair Market Value of Qualified Land Conveyed to a Qualified Conservation Agency

_________________

(Please attach a copy of the formal appraisal)

.40

Multiply Line 1 by 40%

Delaware Land & Historic Resource Conservation Tax Credit Before Limitation

_________________

50,000

Maximum Amount of Credit

Delaware Land & Historic Resource Conservation Credit. Enter the Smaller of Line 3 or Line 4.

_________________

STOP: IF THE TYPE OF ENTITY APPLYING FOR THE CREDIT IS:

• C CORPORATION – Enter the amount from Line 5 on Form 700, Delaware Income Tax Credit Schedule, Line 17(a).

• S CORPORATION – Multiply the amount on Line 5 by the percentage of stock owned by each shareholder. Enter the result on Form 700, Delaware Income

Tax Credit Schedule, Line 17(b).

• PARTNERSHIP – Multiply the amount on Line 5 by the percentage ownership of each partner. Enter the result on Form 700, Delaware Income Tax Credit

Schedule, Line 17(c).

• INDIVIDUAL & SOLE PROPRIETOR – Enter the amount from Line 5 on Form 700, Delaware Income Tax Credit Schedule, Line17(d).

• RESIDENT & NONRESIDENT ESTATES & TRUSTS – Multiply the amount on Line 5 by the percentage share of each beneficiary. Enter the result on Form

700, Delaware IncomeTax Credit Schedule, Line17(e).

• RESIDENT & NONRESIDENT DECEDENT ESTATES – Enter the amount from Line 5 on Form 700, Delaware Income Tax Credit Schedule, Line17(f).

THE TOTAL AMOUNT OF CREDITS APPROVED BY THE DIRECTOR WITH RESPECT TO ALL APPLICANTS FOR THE DELAWARE LAND & HISTORIC

RESOURCE CONSERVATION TAX CREDITS SHALL NOT EXCEED $1,000,000 IN ANY CALENDAR YEAR. IF THE AMOUNT OF DELAWARE LAND &

HISTORIC RESOURCE CONSERVATION TAX CREDITS FOR WHICH ALL TAXPAYERS APPLIED IN ANY CALENDAR YEAR EXCEEDS $1,000,000, THEN

THE DELAWARE LAND & HISTORIC RESOURCE CONSERVATION TAX CREDITS TO BE RECEIVED BY EACH APPLICANT SHALL BE THE PRODUCT OF

$1,000,000 MULTIPLIED BY A FRACTION, THE NUMERATOR OF WHICH IS THE ELIGIBLE DELAWARE LAND & HISTORIC RESOURCE CONSERVATION

TAX CREDIT APPLIED FOR BY THE APPLICANT AND THE DENOMINATOR IS THE TOTAL OF ALL ELIGIBLE DELAWARE LAND & HISTORIC RESOURCE

CONSERVATION TAX CREDITS APPLIED FOR BY ALL APPLICANTS.

NAME

TITLE

DATE

*DF41713019999*

Revised 12/31/13

Form 1801ac 0009 - Application And Computation Schedule For Claiming Delaware Land & Historic Resource Conservation Tax Credits - 2013

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