Form Hr-T - Transfer Of Supplement To Federal Historic Rehabilitation Credit - 2015
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HR-T
Form
Transfer of Supplement to Federal
2015
Historic Rehabilitation Credit
Wisconsin
Department of Revenue
A. Transferor Information
Entity Legal Name (if applicable)
Federal Employer ID Number
Legal Last Name
Legal First Name
M .I .
Social Security Number
X X X-X X-
Number and Street
Suite Number
City
State
Zip Code
Contact Person
Position
Phone Number
Email
B. Transferee Information
Entity Legal Name (if applicable)
Federal Employer ID Number
Legal Last Name
Legal First Name
M .I .
Social Security Number
X X X-X X-
C. Credit Information
1 The credit being transferred is based on:
paid expenditures
completed project
2 Period during which expenditures were paid or project completed:
to
M
M
D
D
Y
Y
Y
Y
M
M
D
D
Y
Y
Y
Y
3 Qualified expenditures on which the credit being transferred is based . . . . . . . . . . . 3
4 Enter 20% of the amount on line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Credit being transferred that has passed through or transferred from other entities:
a Entity Name
FEIN
Amount 5a
b Entity Name
FEIN
Amount 5b
5c Total credits from additional schedule . . . . . . . . . . . . . 5c
6 Total pass through and transferred credits (add lines 5a through 5c) . . . . . . . . . . . . 6
7 Total credit available to be transferred (add lines 4 and 6) . . . . . . . . . . . . . . . . . . . . 7
8 Amount of credit from line 7 to be transferred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
D. Signature of Transferor or Authorized Representative
I hereby certify that to the best of my knowledge and belief 1) the above-listed expenditures were paid during the period
specified and are qualified under section 47(c)(2) of the Internal Revenue Code and 2) the above-listed transferee is
subject to Wisconsin income or franchise tax under s. 71.02, 71.08, 71.23, or 71.43, Wis. Stats.
Print Name
Signature
Date
IC-134 (R. 2-15)
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