Form Tsa - Film Credit Transfer Or Sale Application - 2012

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2012
Form TSA
Massachusetts
Film Credit
Department of
Transfer or Sale Application
Revenue
For calendar year 2012 or taxable year beginning
and ending
Name of transferor
Social Security or Federal Identification number
Street address
City/Town
State
Zip
Name of transferee
Social Security or Federal Identification number
Street address
City/Town
State
Zip
Designated production company representative
Telephone number
E-mail address
Name of project
Street address
City/Town
State
Zip
Certificate Number
Certificate number issued by Massachusetts Department of Revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amount of Film Credit Transferred
Total amount of film credit being transferred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amount paid by transferee for film credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Transfer or Sale Information
If the transferee distributes or assigns any portion of the credit to its partners, members or owners, the transferee must complete a Film Credit Transfer or
Sale Application. A separate application is necessary for every individual or business transfer. Upon approval of the application, the Department of Revenue
will issue a Transfer or Sale Film Credit Certificate indicating the amount of credit transferred.
Tax Return Filing
The certificate number and amount of credit must be entered on the appropriate line of the Massachusetts tax return. Transferees receiving this Transfer or
Sale Film Credit Certificate must also enter the appropriate Transfer or Sale certificate number and amount of credit on the appropriate line of their Mass-
achusetts tax return.
The undersigned is electing to make a transfer or sale of the Massachusetts film credit and is notifying the Department of Revenue of this elec-
tion. A copy of the original certificate should be attached to this application and submitted to the Massachusetts Department of Revenue.
Signature
Date
All film credit information should be mailed to: Massachusetts Department of Revenue, Audit Division, 200 Arlington Street, Room 4300, Chelsea, MA
02150, attn: Film Credit Unit.

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