Virginia Form Pte - Virginia Pass-Through Credit Allocation - 2016
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1*VA0PTC116888*
VIRGINIA
Virginia Pass-Through Credit Allocation
Form PTE
INSTRUCTIONS: Use this form to allocate a tax credit to the taxpayers listed in Section II. All businesses in
Mail Form To:
Section II should be registered with the Department before completing Form PTE. If you are not registered,
Virginia Department of Taxation
use iReg online or complete Form R-1. The information in Section II may be submitted as an attachment provided
Tax Credit Unit
that the attachment lists only the required information. Any pass-through entity listed in Section II must complete a
P.O. Box 715
separate Form PTE. Allocations must be shown in whole dollars and the total allocations listed in Section II must
Richmond, VA 23218-0715
equal the amount shown in Section I, H. To avoid delays at the time of annual return processing, Form PTE should
or
be filed within 30 days of certification, but at least 90 days prior to the participants (listed in Section II) filing their
income tax returns. Please ensure that the information provided on this form is accurate. Documentation will be
Fax to (804) 774-3902
required for any changes. All credits must be allocated by percentage of ownership or participation in the pass-
For assistance, call
through entity except for the Historic Rehabilitation Credit, Qualified Equity and Subordinated Debt Investments Tax
(804) 786-2992.
Credit, Research and Development Expenses Tax Credit, Major Research and Development Expenses Tax Credit,
and Enterprise Zone Act Credit.
You must attach a copy of your certificate. A separate Form PTE must be completed for each certificate.
Section 1 - Credit Information
A) Pass-Through Entity FEIN
B) Pass-Through Entity (Entity Filing Form) Name
C) If Subsidiary, Enter Parent’s FEIN
D) Type of Filer
E) Form Type
F) Disregarded Entity
G) Tax Year
H) Amount Granted/Allocated
I) Certificate Number, if Applicable
Fiscal
Original
Yes
.00
Calendar
Amended
No
J) Credit Type - Check One
(AB) Agricultural Best
(FC) Food Crop Donations
(MR) Major Research &
(RD) Research & Development
Management
Development
(BR) Barge & Rail Usage
(GJ) Green Job Creation
(MP) Motion Picture
(RB) Riparian Buffer
(CO) Community of
(HR) Historic Rehabilitation
(NA) Neighborhood Assistance
(TE) Telework
Opportunity Program
(ES) Educational Scholarship
(IT)
International Trade
(PV) Port Volume Increase
(WR) Worker Retraining
Facility
(EZ) Enterprise Zone
(LV) Livable Home
(ED) Qualified Business
(OT) Other ______________
(nonrefundable)
(WV) Farm Wineries &
(MB) Major Business
(RM) Recyclable Materials
Vineyards
Section ll - Credit Allocation - ALL BUSINESSES MUST BE REGISTERED
1
SSN/FEIN
Name
Amount
.00
Street Address or P.O. Box
City, State, ZIP
2
SSN/FEIN
Name
Amount
.00
Street Address or P.O. Box
City, State, ZIP
3
SSN/FEIN
Name
Amount
.00
Street Address or P.O. Box
City, State, ZIP
4
SSN/FEIN
Name
Amount
.00
Street Address or P.O. Box
City, State, ZIP
5
SSN/FEIN
Name
Amount
.00
Street Address or P.O. Box
City, State, ZIP
TOTAL
.00
Must equal the amount shown in Section I, H
Section lll - Authorized Signature - Must be signed by an authorized representative of the entity.
Authorized Signature of Representative
Title
Date
Print Name
Telephone Number
Fax Number
Email
Va. Dept. of Taxation 2601430 Rev. 08/16
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