Form F-1161 - Application For Rescindment Of Corporate Income Tax And Insurance Premium Tax Credit For Contributions To Nonprofit Scholarship Funding Organizations (Sfos) - 2009

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F-1161
Application for Rescindment of Corporate Income Tax and Insurance Premium
R. 07/09
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 ____________________________________
If included in a consolidated Florida corporate income tax return, provide:
Parent Corporation’s FEIN
Original amount of planned contribution $
,
,
.
Confirmation number of original credit application (if known) __________________________________________________
Enter the name of the SFO the credit was originally approved for:
_________________________________________________________________________________________________________
Enter the taxable year the credit was originally approved for:
/
/
/
/
Beginning date
and ending date
MM
DD
YY
MM
DD
YY
Enter the amount you wish to rescind $
,
,
.
Has any of the above amount already been contributed to the SFO?
q
q
Yes
No
Do you give permission and grant authority to the Florida Department of Education to share the corporation’s name,
q
q
address, telephone number, and tax credit amount with the SFO identified in this application?
Yes
No
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
Date

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