Form Ida-10 - Individual Development Account Tax Credit Application

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Indiana Department of Revenue
Form IDA-10
Individual Development Account Tax Credit Application
SF 48770 (R2/8-05)
File with the: Indiana Housing Finance Authority
30 South Meridian, Suite 1000
Indianapolis, IN 46204
Contributor Information
To be completed jointly by the taxpayer and the Community Development Corporation (CDC)
Name of contributor:
Social security or federal identification number:
Address
Telephone number:
City
State
Zip Code
Contributor’s tax year ending:
Type of income tax return to be filed by contributor. Check One:
Individual Form IT-40
Fiduciary Form IT-41
Partnership Form IT-65
Nonprofit Form IT-20NP
Corporation Form IT-20
S Corporation Form IT-20S
Financial Institution Form FIT-20
Individual Developmental Account Tax Credit Verification
Applicant must sign below and provide proof of payment
Recipient Organization (CDC):
Community Development Corporation’s
TID #
Address
City
State
Zip Code
Date paid:
1. Amount of contribution (minimum $100) .................................
$
Program number:
2. Multiply line 1 by 50% (x .50) .................................................
$
Date filed:
Departmental Use Only
3. Tentative amount of credit, lesser of line 2 or $25,000 .........
$
Date approved by
Signature of contributor
Department of Revenue:
Certification of Contribution
For donation to Individual Development Account Fund established under I.C. 4-4-28-13
I certify that the applicant contributed, within thirty (30) days from the date of acceptance, the amount on line 1 to the CDC Individual Development
Account Fund and that the information stated here is true, correct and complete.
Signature of Not-For-Profit CDC Officer
Title
Date
Do not separate
Leave form intact
Indiana Department of Revenue
For Tax Year
Form IDA-20
Individual Development Account Tax Credit Certificate
Ending
(R2//8-05)
(Code #823)
Departmental Use Only
Attach approved IDA-20 to the contributor’s tax return where the credit is
Social Security or Federal Identification Number:
claimed.
Members of a pass-through entity must attach a copy of Schedule IN K-1 to
their income tax returns when claiming their pro-rata share of the approved
Your request has been:
Approved
Disapproved
IDA-20 credit.
Amount of available credit:
Program Number:
Enter mailing address of contributor:
Name
Signature of Departmental Officer
Address
Date
City
State
Zip Code

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