Form 572 - Transfer Agreement For Income Tax, Rural Electric Cooperatives Tax, Or Insurance Premium Tax Credit
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1
2
3State of Oklahoma
Transfer Agreement for Income Tax,
572
Rural Electric Cooperatives Tax,
or Insurance Premium Tax Credit
Revised 2016
(See a list of transferable credits, the statutory reference and information on the Tax Credit Moratorium on pages 2 and 3)
On this ______ day of __________________, 20_____, the transferor identified below, for good and valuable consid-
eration, hereby sells, conveys and transfers to the transferee, also identified below, $ _________________________ of
certain tax credits, (“credits”) earned under the applicable Oklahoma Statute (OS). The transferred credits were originally
allowed to the transferor in the tax year(s) of ____________________________________ (allowed year[s]). Enter the
tax year(s) for which the credit may be claimed ___________________________________. Enclose a copy of the original
Oklahoma Tax Commission (OTC) acknowledgment of credits issued to the transferor. If the current transferor obtained
the credits by prior transfer, also enclose a copy of the prior transfer agreement.
Credit
Type of Credit __________________________________________________________________
Transferor
Name ________________________________________________________________________
Address ______________________________________________________________________
Federal Employer Identification Number
or Social Security Number
____________________________________________
Transferee
Name ________________________________________________________________________
Address ______________________________________________________________________
Federal Employer Identification Number
or Social Security Number
____________________________________________
The transferor hereby represents that it has neither claimed for its own behalf nor conveyed to any other transferee the
credits transferred by this agreement.
The parties agree that the transferor, on behalf of both parties, shall file a copy of this jointly executed agreement within
30 days of the date of transfer with the OTC. The transferee also agrees that it shall file a copy of this agreement with the
income tax return, rural electric cooperatives tax return or insurance premium tax return on which it claims the transferred
credits or if it subsequently transfers the credits, that it will execute and file a similar agreement.
Effective on the date stated above, the transferor and transferee agree to the transfer of the credits as described above.
Transferor...
Transferee...
By _______________________________
By _______________________________
Company _________________________
Company _________________________
Certificate of Mailing...
A copy of the agreement was filed by first class U. S. Mail on the ______ day of ________________, 20____, with proper
postage thereon fully prepaid to the following:
Oklahoma Tax Commission
Compliance Division: Corporate Income Tax
Attention: Tax Credit Transfer Agreement
P.O. Box 269054, Oklahoma City, OK 73126-9054
Signature
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