Form Htc-V-2013 - Rhode Island Historic Structures Tax Credit Processing Fee Form
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1State of Rhode Island and Providence Plantations
Form HTC-V-2013
13130399990101
Historic Structures Tax Credit Processing Fee Form
Name
Federal employer identification number
Address
Address 2
City, town or post office
State
ZIP code
E-mail address
Part A - Project Information
1
Project name:
2
Project location:
3
Project number:
Complete lines 1, 2, 3 and 7. If you wish to revise the amounts from your Form HTC-13, complete
Part B - Processing Fee Calculation
lines 1 through 7. NOTE: You cannot receive more Historic Preservation Tax Credits 2013 than
what you initially applied for. If line 6 is more than line 3, you must change line 4 or 5, or both.
Estimated Qualified Rehabilitation Expenditures from 2013 application - Form HTC-13........
1
1
%
Credit Percentage Elected - 20% or 25% from 2013 application - Form HTC-13.....................
2
2
Estimated Historic Preservation Tax Credits 2013 from 2013 application - Form HTC-13...........
3
Revised Estimated Qualified Rehabilitation Expenditures.............................................................
4
4
%
Revised Credit Percentage Elected - 20% or 25%........................................................................
5
CANNOT BE MORE THAN
Revised Estimated Historic Preservation Tax Credits 2013 amount..
6
6
LINE 3 CREDIT AMOUNT
Total processing fee due. Multiply line 1 or line 4, whichever is applicable, by 3% (0.0300)..
7
7
Make cashier’s check or money order payable to the RI Division of Taxation. This fee is non-refundable.
Pursuant to R.I.G.L. 44-33.6, Historic Preservation Tax Credits 2013, applicants are required to pay a non-refundable
processing fee equal to 3% of Qualified Rehabilitation Expenditures as estimated on their Application for Rhode Island
Historic Preservation Tax Credits 2013.
If you are revising the amount of Estimated Qualified Rehabilitation Expenditures for which you initially applied on your Appli-
cation for Rhode Island Historic Preservation Tax Credits 2013, you acknowledge and agree that you waive all rights, claims
and entitlements to Historic Preservation Tax Credits associated with the difference between the amount initially applied for
(line 3) and the revised amount noted on line 6 above.
This 3% non-refundable processing fee must be paid prior to entering into a contract with the RI Division of Taxation under
this program. Qualified applicants have 30 days from the date of Part 2 certification from the RI Historical Preservation &
Heritage Commission to pay this non-refundable fee, and enter into a contract with the RI Division of Taxation.
Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief, it is true, accurate and complete.
Applicant signature
Print name
Date
Telephone number
Applicant address
City, town or post office
State
ZIP Code
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