Form Lpc-2 - Notification Of Transfer Of Land Preservation Credit

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Notification of Transfer of
Form
*VALPC2113888*
Land Preservation Credit
LPC-2
Mail form and payment to:
Credits derived from donations made on and after January 1, 2007, are not automatic, but must be
reviewed by the Department of Taxation to ensure that the annual limitation is not exceeded. Some
Virginia Department of Taxation
credit applications require review and approval by the Department of Conservation and Recreation
Tax Credit Unit
before the Department of Taxation can act.
PO Box 26544
All credits, whether arising from donations before or after January 1, 2007, are subject to adjustment
by the Department of Taxation upon audit.
Richmond, VA 23261-6544
To avoid delays at the time of annual return processing, Form LPC-2 should be filed by the credit
For assistance, call
holder within 90 days of the credit transfer, but at least 90 days before filing your annual return.
The sale or transfer of tax credits may have income tax consequences for the credit holder and
(804) 786-2992.
transferee. Consult an attorney, a tax professional, or the IRS.
Section I - Current Credit Holder Information
A) Credit Holder Name (Legal Name)
B) Credit Holder Identification Number (Check appropriate box and enter number.)
 SSN
 FEIN
C) Street Address or PO Box Number
City
State
ZIP Code
D) Contact Name, If Different From Above
E) Phone Number
F) FAX Number
G) Email
Section II - Declaration, Signature and Notarization
I (we) the undersigned declare, under the penalties provided by law, that this form (including any accompanying schedules and statements) has been
examined by me (us) and is, to the best of my (our) knowledge and belief, a true, correct and complete notification form, made in good faith pursuant
to the income tax laws of the Commonwealth of Virginia. I (we) understand that the Department of Taxation will record the information submitted
on this notification; however, acceptance of this notification form does not constitute certification, approval, or validation of the transfer or
valuation of this credit by the Department of Taxation. If a person other than the taxpayer prepares this notification, their declaration is based on
all information of which they have knowledge.
I authorize the Department of Taxation to discuss my notification with the contact person listed in Section I, II or Schedule A and my broker,
if applicable. In addition, I authorize the Department of Taxation to disclose to the transferee(s) of the credit any confidential tax information
relevant to the eligibility and value of the credit transferred when such disclosure is necessary.
Signature of Credit Holder
Signature of Credit Holder
Must Be
Print Name
Print Name
Signed in
Presence
of Notary
Title
Title
Date
Date
Notary Information
Subscribed and sworn before me this ___________day of ____________________________,
20_____, in the (City/County) _____________________________, of Virginia.
Notary Public Signature
Date
Notary Public Name Printed
My Commission Expires
Signature of Broker or Representative
Print Name
Date
Address of Broker or Representative
Broker FEIN
Phone Number
Office Use Only:
1

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