Form Loa - Loan-Out Affidavit/allocation - 2014 (Page 3 of 3) in pdf

Schedule LOA Instructions

The Loan-Out Affidavit is a form the production company is required

What is the Loan-Out Affidavit?

Payments to Personal Service / Loan-out

to complete and submit for each and every personal service/loan-

(To be completed by the production company)

Companies

out company whose wages are included on the Film Credit Applica-

tion. Failure by the production company to complete and submit a

Enter the total amount of wages paid to the personal service/loan-

Loan-Out Affidavit for a personal service/loan-out company will result

Line 1

out company for the production everywhere.

in disallowance of the credit claimed in relation to such personal

service / loan-out company.

Enter the total amount of qualified wages paid to the personal serv-

Note: The affidavit must be completed in full and signed with origi-

Line 2

ice/loan-out company for the production in Massachusetts.

nal signatures by an authorized representative of the production

company, an authorized representative of the personal service/

loan-out company and the actor / performer in order to be valid

Please check Yes or No to verify that all wages paid the personal

Line 3

and accepted.

service/loan-out company are for services performed in Massachu-

setts and constitute Massachusetts source income to the personal

service / loan-out company. The production company must check

Production companies who are claiming wages for amounts paid to

Who Must File a Loan-Out Affidavit?

either Yes or No.

personal service/ loan-out companies on the Massachusetts Appli-

cation for Payroll / Production Credit must file the affidavit with their

application for credit. A separate Loan-Out Affidavit must be com-

Under Massachusetts Regulation 830 CMR 62B.2.3, the production

Line 4

pleted and filed with the Massachusetts Application for Payroll / Pro-

company is required to register and withhold on payments made to

duction Credit for each personal service/loan-out company included

loan-out companies. Check Yes to verify that the production com-

on the application for credit.

pany has complied with the regulation.

Note: A copy of the signed affidavit should be retained by the loan-

out company and the actor / performer for their records and to attach

Enter the total amount of Massachusetts withholding tax remitted to

Line 5

to their Massachusetts income tax returns as required.

Massachusetts relating to the wages paid to this loan-out company.

Complete the general information section of this application with the

General Information

Enter the range of dates that this loan-out company performed serv-

Line 6

information requested. On the Massachusetts production informa-

ices in Massachusetts relating to the wages on line 2.

tion line, enter the first date that the production company did work in

Massachusetts and the final day the production company did work

in Massachusetts on this production.

Enter the date or dates withholding tax payments were made to

Line 7

Massachusetts.

This section is to be completed and signed by an authorized repre-

Note: The completed form must be filed with the Application for Pay-

Personal Service/Loan-out Company Information

sentative of the personal service / loan-out company. All sections

roll / Production Credit.

must be completed in order for the wages to be included on the pro-

Mail to: Massachusetts Department of Revenue, Audit Division,

duction company’s credit application. The Massachusetts start and

200 Arlington Street, Room 4300, Chelsea, MA 02150, attn.: Film

end dates are the first date that the personal service/loan-out com -

Credit Unit.

pany did work in Massachusetts and the final day the personal serv-

ice/loan-out company did work in Massachusetts on this production.

This section is to be completed and signed by the actor / performer.

Actor / Performer Information

All sections must be completed in order for the wages to be included

on the production company’s credit application. The Massachusetts

start and end dates are the first date that the actor / performer did

work in Massachusetts and the final day the actor / performer did

work in Massachusetts on this production.

Form Loa - Loan-Out Affidavit/allocation - 2014 Page 3

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