Form Dr-116200 - Florida Tax Credit Scholarship Program Notice Of Intent To Transfer A Tax Credit

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DR-116200
R.01/18
TC
Florida Tax Credit Scholarship Program
Rule 12-29.003
Florida Administrative Code
Notice of Intent to Transfer a Tax Credit
Effective 01/18
To transfer a tax credit available under the Florida Tax Credit Scholarship Program, the transferring business and the receiving business must
both be members of the same affiliated group of corporations.
Part I - Transferring Business Information
Federal Employer Identification Number (FEIN):
Business Name:
Business Address:
City:
State:
ZIP
Contact Person Name:
Telephone Number:
Email Address:
Parent FEIN:
If the transferor is included in a consolidated Florida corporate income tax return, please provide the Parent Corporation Name:
Florida Tax Credit Scholarship Program:
Indicate the type of tax credit allocation or tax
credit to be transferred, information on the
Corporate Income Tax
original amount of the tax credit allocation,
Insurance Premium Tax
any approved carryforward amounts, the
Tax on Oil Production
amount of any previous transfers, and the
amount to be transferred. For transfers of
Tax on Gas Production
sales and use tax or the excise tax on liquor
Sales and Use Tax (enter certificate number):
beverages, wine beverages, or malt
Excise Tax on Liquor Beverages (enter license number):
beverages, indicate the certificate number or
Excise Tax on Wine Beverages (enter license number):
license number for which the tax credit
allocation was authorized.
Excise Tax on Malt Beverages (enter license number):
Tax Credit Allocation and Tax Credit Information:
Original Tax Credit Allocation
Original Amount of Tax Credit Allocation
$
Tax Credit Allocation Confirmation Number
Tax Year or State Fiscal Year Approved to Make a Contribution
Amount Claimed
$
Tax Year or Month/Year Claimed
Approved Carryforward Amounts
Amount of Approved Tax Credit Carryforward
$
Carryforward Confirmation Number
Carryforward Amount Claimed
$
Tax Year or Month/Year Carryforward Claimed
Prior Transfers
Amount Previously Transferred
$
$
Unused Amount
Amount to be Transferred:
$
Part II - Receiving Business Information -
A separate notice is required for each receiving business.
Federal Employer Identification Number (FEIN):
Business Name:
Business Address:
ZIP
City:
State:
Contact Person Name:
Telephone Number:
Email Address:
Parent FEIN:
If the transferee is included in a consolidated Florida corporate income tax return, please provide the Parent Corporation Name:

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