Form Fit Cs - Financial Institutions Tax (Fit) Credit Schedule Page 2

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Credit Schedule

(If credits are being claimed by members of an afﬁ liated group, a separate schedule is required for each entity that is claiming a credit.)

Entity entitled to credit: Name

FEIN

FIT account number

Nonrefundable Credits

Must attach credit certiﬁ cate received from the Ohio Development Services Agency or Ohio Department of Commerce.

Credit Earned

Credits Claimed

Opening Unused

Closed Unused

During Current

Credit Balance

Reporting Period

1. Bank organization assessment

N/A

tax credit

2. New markets tax credit

3. Qualiﬁ ed research expenses

credit

4. Qualifying dealers in intangibles

N/A

tax credit (2014 only)

5. Jobs retention tax credit

Refundable Credits

Must attach credit certiﬁ cate received from the Ohio Development Services Agency.

1. Historic preservation tax credit – Schedule B, line 1 ................................................................................................ 1.

2. Jobs retention or jobs creation tax credit – Schedule B, line 2 ................................................................................. 2.

3. Tax credit for losses on loans made under the Ohio venture capital program – Schedule B, line 3 ......................... 3.

4. Ohio motion picture production tax credit – Schedule B, line 4 ................................................................................ 4.

5. Total of lines 1 through 4 .......................................................................................................................................... 5.

Declaration and Signature

(An ofﬁ cer or managing agent of the corporation must sign this declaration.)

I declare under penalties of perjury that this report (including any

use any of its money or property for or in aid of or opposition to

accompanying schedule or statement) has been examined by

a political party, a candidate for election or nomination to public

me and to the best of my knowledge and belief is a true, correct

ofﬁ ce, or a political action committee, legislation campaign fund,

and complete return and report, and that this corporation has not,

or organization that supports or opposes any such candidate or

during the preceding year, except as permitted by Ohio Revised

in any manner used any of its money for any partisan political