Arizona Form 334-O - Transferor Notice Of Transfer Of Motion Picture Credits - 2015

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Transferor Notice

Arizona Form

2015

334-O

of Transfer of Motion Picture Credits

DO NOT MAIL COMPLETED FORM WITH TAX RETURN.

The transferor must submit this notice to the Department of Revenue within 30 days after the sale or transfer. Each form

must be for a transfer of a single credit by a transferor to one or more transferees. If you have more than one credit you

are transferring, complete a separate Form 334-O for each credit.

Transferor Information

Name

TIN

Address – number and street or PO Box

City, Town or Post Office

State

ZIP Code

Authorized Contact Person

Telephone Number (with area code)

Motion Picture Production Company Information

Name

TIN

Address – number and street or PO Box

City, Town or Post Office

State

ZIP Code

Authorized Contact Person

Telephone Number (with area code)

Credit Information

1 Credit post-approval number ......................

4 Transfer credit balance before transfer ......

2 Amount of transfer from page 2,

Part D, line 5 ...............................................

5 Transfer credit remaining after transfer ......

MM D D Y Y Y Y

3 Date of transfer ...........................................

Transferee Information

Enter the transferee information on page 2 of this form.

Signature

The transferor hereby represents that it has neither claimed for its own behalf nor conveyed to any other transferee the credit for motion picture

production costs transferred in this notice. Effective as of the date of transfer shown in this notice, the transferor agrees to transfer the credit amount

shown on line 2 above.

TRANSFEROR SIGNATURE

TAXPAYER NAME (print or type)

TITLE

TELEPHONE NUMBER (with area code)

Do not mail completed form with tax return. Mail form separately to:

Arizona Department of Revenue • Office of Economic Research and Analysis • PO Box 29099 • Phoenix, AZ 85038-9099

ADOR 10718 (15)

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