Form Rev-774 Ct - Assignment Of Tax Credit
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REV-774 CT (06-15)
ASSIGNMENT
OF
TAX CREDIT
BUREAU OF CORPORATION TAXES
ACCOUNTING DIVISION
PO BOX 280701
Please Type or Print
HARRISBURG PA 17128-0701
This notice is to authorize the assignment of tax credit(s)
PLEASE SUBMIT IN DUPLICATE
From:
Assignor (holder of the credit)
START
Name of Owner (Individual, Partnership, Corporation, etc.)
Federal Employer Identification Number (FEIN)
Trade Name (If other than preceding line)
Type of Tax (Sales, Corporation, etc.)
Street Address
City
State
ZIP
Revenue ID Number
TYPE OF TAX AND IDENTIFICATION NUMBER
MONTH/YEAR OR TAX NOTICE NUMBER
AMOUNT TO BE CREDITED
To:
Assignee (receiver of credit)
Name of Owner (Individual, Partnership, Corporation, etc.)
Federal Employer Identification Number (FEIN)
Trade Name (If other than preceding line)
Type of Tax (Sales, Corporation, etc.)
Street Address
City
State
ZIP
Revenue ID Number
TYPE OF TAX AND IDENTlFlCATION NUMBER
MONTH/YEAR OR TAX NOTICE NUMBER
AMOUNT TO BE CREDITED
For value received, the above-named assignor sells, transfers and assigns to the assignee, the credit(s) listed above
Signed this
day of
.
MONTH, YYYY
DAY
If Proprietorship or Partnership
If Corporation
Signature
Signature of Corporate Officer
Please Sign after printing.
Please Sign after printing.
Signature
Officer Title
Please Sign after printing.
Telphone Number
Telephone Number
Reset Entire Form
PRINT FORM
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Parent category: Financial