Form 569 Draft - Reporting Form For The Transfer Or Allocation Of A Tax Credit Page 2
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9/26/13
Form 569 - Page 2
Reporting Form for the Transfer or Allocation of a Tax Credit (
Title 68 OS Section 2357.1A-2)
Part 4 – Complete if any portion of the credit was allocated
Name of Shareholder, Partner or Member
FEIN/SSN
$ Amount of Credit Allocated
“X” if a PTE
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Total from Supplemental Schedule
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Total amount of credit that was allocated (add Part 4 lines 1 - 33)
34)
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