Form Pte - Virginia Pass-Through Credit Allocation

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Form PTE Virginia Pass-Through Credit Allocation
*VA0PTC112888*
• Use this form to allocate a tax credit to the taxpayers listed in Section II.
All businesses in Section II should be registered with the Virginia Department of
Taxation before completing Form PTE. If you are not registered, use iReg online or
complete Form R-1.
Mail Form to:
• The information in Section II may be submitted as an attachment provided that the
attachment lists only the required information.
Virginia Department of Taxation
• Any pass-through entity listed in Section II must complete a separate Form PTE.
Tax Credit Administration Unit
• Allocations must be shown in whole dollars and the total allocations listed in Section II
PO Box 715
must equal the amount shown in Section I, H.
Richmond, VA 23218-0715
• To avoid delays at the time of annual return processing, Form PTE should be filed within
or
30 days of certification, but at least 90 days prior to the participants (listed in Section
Fax to: 804-786-2800
II) filing their Income Tax Returns.
For assistance, call 804-786-2992.
• Please ensure that the information provided on this form is accurate. Documentation will
be required for any changes.
You must attach a copy of your certificate. A separate Form PTE must be completed for each certificate.
Section l - Credit Information
A) Pass-Through Entity FEIN
B) Pass-Through (Entity Filing Form) Name
C) If Subsidiary, Enter Parent FEIN
D) Type of Filer
E) Form Type
F) Disregarded
G) Tax Year
H) Amount Granted/Allocated
I) Certificate Number, If Applicable
Entity
Fiscal
Original
Yes
.00
Calendar
Amended
No
J) Credit Type - Check One
(EZ) Enterprise Zone (nonrefundable)
(LV) Livable Home
(RD) Research & Development
(AB) Agricultural Best
(WV) Farm Wineries & Vineyards
(NA) Neighborhood Assistance
(RB) Riparian Buffer
Management
(GJ) Green Job Creation
(PV) Port Volume Increase
(WR) W orker Retraining
(BR) Barge & Rail Usage
(HR) Historic Rehabilitation
(ED) Qualified Business
(OT) Other ______________
(CO) Community of
(IT) International Trade Facility
(RM) Recyclable Materials
Opportunity Program
Section ll - Credit Allocation - ALL BUSINESSES MUST BE REGISTERED
Taxpayer Information
1
SSN/FEIN
Name
Amount
00
Street Address or P. O. Box
City, State ZIP
2
SSN/FEIN
Name
Amount
00
Street Address or P. O. Box
City, State ZIP
3
SSN/FEIN
Name
Amount
00
Street Address or P. O. Box
City, State ZIP
4
SSN/FEIN
Name
Amount
00
Street Address or P. O. Box
City, State ZIP
5
SSN/FEIN
Name
Amount
00
Street Address or P. O. Box
City, State ZIP
6
SSN/FEIN
Name
Amount
00
Street Address or P. O. Box
City, State ZIP
00
Total
Must equal the amount shown in Section l, H.
Section lll - Authorized Signature - Must be signed by an authorized representative of the entity.
Authorized Signature or Representative
Title
Date
Print Name
Telephone Number
FAX Number
Va. Dept. of Taxation 2601430 PTE W (Rev. 10/12)
Email Address

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