Form Rev-1123 Ct - Educational Improvement Tax Credit Election Form Page 2

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REV-1123 CT (05-12)
SECTION II
Complete this section for each shareholder, member or partner receiving a pass-through Educational Improvement
Tax Credit. Attach additional schedules if necessary.
Name and address of each owner having an interest in
Social Security
Percentage of
Total amount of
Taxable year to
the entity. Include name, street, city, state, ZIP.
number
distributive
EITC credit to pass
apply the pass-
income to which
through to the
through EITC on
the owner is
owner (pass-
behalf of the
entitled
through amount
owner (must be
x% of distributive
the same for all
income to which
owners)
the owner is enti-
tled). Also record
on PA Schedule OC.
YYYY
%
%
%
%
%
%
%
%
%
%
%
%
%
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