Form Mo-Tf - Missouri Tax Credit Transfer Form
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Missouri Department of Revenue
Form
Missouri Tax Credit Transfer Form
MO-TF
The Missouri Tax Credit Transfer Form (MO-TF) must be used when transferring any transferable Missouri tax credits listed on page 2.
Submit a separate Form MO-TF for each tax credit transfer.
Name
Federal Employer I.D. Number (FEIN)
Missouri Tax I.D. Number
Social Security Number
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Contact Person
Title
Address
City
State
Zip Code
Telephone Number
Fax Number
E-mail
(___ ___ ___)___ ___ ___-___ ___ ___ ___
(___ ___ ___)___ ___ ___-___ ___ ___ ___
Tax Credit Program
Approved Tax Benefit Number
Issued For the Calendar Year ____________ or Tax Year Beginning __________________________, Ending __________________________.
Amount of Tax Credits Sold
Discount Rate
Sale Price
$
%
$
$
%
$
$
%
$
Total amount of credits to be transferred.....................................
$
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. I also certify that I am
an authorized representative of the Assignor and I am authorized to make the statement of affirmation contained herein.
Assignor Signature
Title
Print Name
Date (MM/DD/YYYY)
___ ___ / ___ ___ / ___ ___ ___ ___
Subscribed and sworn before me, this
Embosser or black ink rubber stamp seal
day of
year
State
County (or City of St. Louis)
My Commission Expires (MM/DD/YYYY)
__ __ /__ __ /__ __ __ __
Notary Public Signature
Notary Public Name (Typed or Printed)
Name
Federal Employer I.D. Number (FEIN)
Missouri Tax I.D. Number
Social Security Number
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Contact Person
Title
Address
City
State
Zip Code
Telephone Number
Fax Number
E-mail
(___ ___ ___)___ ___ ___-___ ___ ___ ___
(___ ___ ___)___ ___ ___-___ ___ ___ ___
Form MO-TF (Revised 12-2013)
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