Form 25-117 - Texas Certified Investor Annual Notification Of Credit Transfer
Download a blank fillable Form 25-117 - Texas Certified Investor Annual Notification Of Credit Transfer in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 25-117 - Texas Certified Investor Annual Notification Of Credit Transfer with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
225-117
Program I
(Rev.1-12/3)
PRINT FORM
CLEAR FIELDS
Texas Certified Investor Annual Notification of Credit Transfer
A Certified Investor in a Texas Certified Capital Company (CAPCO) must complete and attach a Transfer Affidavit (Form 25-118) for each
insurer to whom credits are transferred.
Notification for Tax Year __________
• See instructions on back.
Name of Certified Investor
Taxpayer Number
Address
City
State
ZIP Code
Name of Contact Person
Phone Number (Area code and number)
FAX number (Area code and number)
Email address
AMOUNT OF
TOTAL CREDITS TO BE TRANSFERRED
CAPCO THAT
ORIGINAL INVESTMENT
(Whole dollars only)
RECEIVED INVESTMENT
$
$
AMOUNT OF CREDIT
PROPORTIONATE ANNUAL
Insurer Receiving Credit Transfer
Taxpayer Number
TRANSFERRED
SHARE OF CREDIT AVAILABLE
TO EACH INSURER
Transferee Contact Name
Contact phone (Area code and number)
$
$
AMOUNT OF CREDIT
PROPORTIONATE ANNUAL
Insurer Receiving Credit Transfer
Taxpayer Number
TRANSFERRED
SHARE OF CREDIT AVAILABLE
TO EACH INSURER
Transferee Contact Name
Contact phone (Area code and number)
$
$
Insurer Receiving Credit Transfer
Taxpayer Number
PROPORTIONATE ANNUAL
AMOUNT OF CREDIT
SHARE OF CREDIT AVAILABLE
TRANSFERRED
TO EACH INSURER
Transferee Contact Name
Contact phone (Area code and number)
$
$
AMOUNT OF CREDIT
PROPORTIONATE ANNUAL
Insurer Receiving Credit Transfer
Taxpayer Number
TRANSFERRED
SHARE OF CREDIT AVAILABLE
TO EACH INSURER
Transferee Contact Name
Contact phone (Area code and number)
$
$
Insurer Receiving Credit Transfer
Taxpayer Number
AMOUNT OF CREDIT
PROPORTIONATE ANNUAL
TRANSFERRED
SHARE OF CREDIT AVAILABLE
TO EACH INSURER
Transferee Contact Name
Contact phone (Area code and number)
$
$
Insurer Receiving Credit Transfer
Taxpayer Number
AMOUNT OF CREDIT
PROPORTIONATE ANNUAL
TRANSFERRED
SHARE OF CREDIT AVAILABLE
TO EACH INSURER
Transferee Contact Name
Contact phone (Area code and number)
$
$
AMOUNT OF CREDIT
PROPORTIONATE ANNUAL
Insurer Receiving Credit Transfer
Taxpayer Number
TRANSFERRED
SHARE OF CREDIT AVAILABLE
TO EACH INSURER
Transferee Contact Name
Contact phone (Area code and number)
$
$
You have certain rights under Chapters 552 and 559, Government Code, to review,
TOTALS
$
$
request and correct information we have on file about you. Contact us at the address
or phone number listed on this form.
I declare that the information in this document and all attachments are true and correct to the best of my knowledge and belief.
Authorized agent
Preparer’s name (please print)
Daytime phone (area code and number)
Date
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial