Transferee Notice
Arizona Form
2015
334-E
of Transfer of Motion Picture Credits
DO NOT MAIL COMPLETED FORM WITH TAX RETURN.
The transferee must submit this notice to the Department of Revenue within 30 days after the sale or transfer. The notice
must be accompanied by a processing fee of 1% of the transfer amount or $200, whichever is less. Notices that are not
accompanied by the fee will be rejected.
How to Compute the Processing Fee:
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
88
Multiply the amount of transfer by 1% (.01).
Round dollar amounts to the nearest whole dollar. If 50 cents or more,
round up to the next dollar. If less than 50 cents, round down.
If the result is less than $200, enter the amount. If the amount is equal to
or greater than $200, enter $200.
Make checks payable to Arizona Department of Revenue.
81 PM
66 RCVD
Processing fee enclosed ...................................
$
00
A
Transferee 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)
B
Motion Picture Production Company Information
Name
TIN
Address – number and street or PO Box
City, Town or Post Office
State
ZIP Code
Credit Information
C
Date of Transfer
Amount of Transfer
Credit Post-Approval Number
M M D D Y Y Y Y
$
.00
Transferor Information
D
Name
TIN
Authorized Contact Person
Telephone Number (with area code)
Signature
$
.00
Effective as of the transfer date, the transferee has received a credit for motion picture production costs for
from the
transferor noted above.
TRANSFEREE SIGNATURE
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 10717 (15)
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