Form 8874(K)-C - Kentucky New Markets Development Program Tax Credit Request For Refund Of Performance Fee

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8874(K)-C
41A720-S83 (5-15)
Commonwealth of Kentucky
KENTUCKY NEW MARKETS DEVELOPMENT PROGRAM TAX CREDIT
DEPARTMENT OF REVENUE
REQUEST FOR REFUND OF PERFORMANCE FEE
➤ See instructions.
A
B
C
Name of Qualified Community
Federal Identification Number
Kentucky Corporation/LLET
Development Entity (CDE)
of CDE
Account Number (if applicable)
of CDE
D
Number and Street (taxpayer’s address)
Certified purchase price of
the qualified equity investment
City
State
Zip Code
$
E
F
Date of this request for refund of performance
What type of entity is the CDE?
fee
¨ Corporation
¨ Limited Liability Pass-through Entity
/
/
¨ General Partnership
¨ Other ___________________________________________
Mo.
Day
Yr.
1. Enter the amount of the qualified equity investment certified by the department which the
CDE received cash in exchange for qualified equity investment within 90 days after the
qualified equity investment was certified .......................................................................................................
2. Enter the amount of the qualified equity investment in qualified active low-income community
businesses located in the Commonwealth 12 months after the CDE received cash in exchange
for the qualified equity investment .................................................................................................................
%
3. Divide line 2 by line 1 and enter the resultant percentage here ...................................................................
100%
4. Percentage required to be invested outlined under KRS 141.433(6) ........................................................
5. If line 3 is smaller than line 4, subtract line 3 from line 4 and enter the resultant percentage here;
%
otherwise, enter 0%....................................................................................................................................
6. Enter the refundable performance fee paid by the CDE ............................................................................
7. Multiply the percentage on line 5 by the amount on line 6, this is the amount of the forfeited
performance fee .........................................................................................................................................
8. Subtract the amount on line 7 from the amount on line 6 and enter here; this is the amount of
performance fee to be refunded ................................................................................................................
Under the penalty of perjury, I declare that I have examined the information on this form, including all accompanying
documents and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
By:__________________________________________________________
__________________________________________________
Signature of executive officer of CDE
Date
Print name: __________________________________________________
Title: ________________________________________________________
Department of Revenue Use Only
A refund of the performance fee is approved in the amount of ............................................... _____________________
By: ___________________________________________
Date: _____________________
Mail to Department of Revenue, Division of Corporation Tax, Station 52, 501 High Street, Frankfort, KY 40601-2103.

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