M M D D Y Y Y Y
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Form CLT-4, Page 6
Period End Date
FEIN
Schedule C - Tax Credits
Column A
Column B
Column C
Type of Credit
Current Year
Total
Current Year
Earned
Available
Applied
Nonrefundable Credits
1. New/Expanded Industry Credit
00
00
00
2. Montana Dependent Care Assistance Credit (include Form DCAC)
00
00
00
3. Montana College Contribution Credit (include Form CC)
00
00
00
4. Health Insurance for Uninsured Montanans Credit (include Form HI)
00
00
00
5. Montana Recycle Credit (include Form RCYL)
00
00
00
6. Alternative Energy Production Credit (include Form AEPC)
00
00
00
7. Contractor’s Gross Receipts Tax Credit (include supporting schedule)
00
00
00
8. Alternative Fuel Credit (include Form AFCR)
00
00
00
9. Infrastructure Users Fee Credit (include Form IUFC)
00
00
00
10. Qualifi ed Endowment Credit (include Form QEC)
00
00
00
11. Historical Buildings Preservation Credit (include federal Form 3468)
00
00
00
12. Increase Research and Development Activities Credit
00
00
13. Mineral and Coal Exploration Incentive Credit (include Forms
00
00
00
MINE-CRED and MINE-CERT)
14. Empowerment Zone Credit
00
00
00
15. Film Employment Production Credit – Nonrefundable (include Form
FPC)
00
00
00
16. Biodiesel Blending and Storage Credit (include Form BBSC)
00
00
00
17. Oilseed Crushing and Biodiesel/Biolubricant Production Credit
(include Form OSC)
00
00
00
18. Geothermal System Credit (include Form ENRG-A)
00
00
00
19. Add lines 1 through 18 and enter the result. This is your total
00
00
00
nonrefundable credits.
Refundable Credits
Film Employment Production Credit – Refundable (include Form
20.
FPC)
00
00
00
21. Film Qualifi ed Expenditures Credit (include Form FPC)
00
00
00
22. Insure Montana Small Business Health Insurance Credit
00
00
00
23. Temporary Emergency Lodging Credit (include Form TELC)
00
00
00
24. Add lines 20 through 23 and enter the result. This is your total
refundable credits.
00
00
00
Tax Credits Recapture
25. Qualifi ed Endowment Credit Recapture
00
26. Historical Buildings Preservation Credit Recapture
00
27. Film Production Credit Recapture
00
28. Biodiesel Blending and Storage Credit Recapture
00
29. Oilseed Crushing and Biodiesel/Biolubricant Production Credit
Recapture
00
30. Add lines 25 through 29 and enter the result. This is your total
00
recapture of tax credits.
31. Add totals of lines 19 and 24; then subtract line 30. Enter the result
here. This is the total of your credits. Enter the total in column C
on Form CLT-4, page 4, line 13.
00
00
00
To receive these credits, you will have to include this Schedule C and the applicable credit forms or other required information.
*12EP0601*
*12EP0601*