Form 8874(K)-A (State Form 41a720-S81) - Notice Of Kentucky New Markets Development Program Tax Credit And Certification

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8874(K)-A
*1200020320*
41A720-S81 (6-12)
Commonwealth of Kentucky
NOTICE OF KENTUCKY NEW MARKETS DEVELOPMENT
DEPARTMENT OF REVENUE
PROGRAM TAX CREDIT AND CERTIFICATION
➤ See instructions.
A
B
C
Name of Qualified Community
Federal Identification Number
Kentucky Corporation/LLET
Development Entity (CDE)
of CDE
Account Number (if applicable)
of CDE
D
E
F
Name of taxpayer making the qualified
Identification number of taxpayer
Kentucky Corporation/LLET
equity investment
Account Number (if applicable)
of taxpayer
Number and Street (taxpayer’s address)
G
Certified purchase price of
the taxpayer’s qualified equity
investment
City
State
Zip Code
$
H
I
Date the CDE received cash for
What type of entity is the taxpayer?
taxpayer’s qualified equity investment
¨ Individual
¨ Estate
¨ Trust
¨ General Partnership
/
/
¨ Corporation
¨ S Corporation
¨ Limited Liability Pass-through Entity
Mo.
Day
Yr.
Under penalties of perjury, I declare that I have examined this form, including all
accompanying documents and statements, and to the best of my knowledge and belief,
it is true, correct and complete.
______________________________________
______________________________________
Signature of executive officer of CDE
Date
__________________________________________________________________________________
Type or print name and title
Department of Revenue Use Only
1. Total Allowable Credit
(add lines 2a through 2g)
$
2. a. Allowable credit: Year 1
$
0
b. Allowable credit: Year 2
$
0
c. Allowable credit: Year 3 (7%)
$
d. Allowable credit: Year 4 (8%)
$
e. Allowable credit: Year 5 (8%)
$
f. Allowable credit: Year 6 (8%)
$
g. Allowable credit: Year 7 (8%)
$
The above tax credits are approved for each year.
By: ___________________________________________
Date: _____________________
Mail to Department of Revenue, Division of Corporation Tax, Station 52, 501 High Street, Frankfort, KY 40601–2103.

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