Form Mo-Tf - Missouri Transfer Form

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MISSOURI TRANSFER FORM (MO-TF)
The Missouri Transfer Form (MO-TF) must be used when transferring any transferable Missouri Tax Credits administered
by the Missouri Department of Economic Development. You must submit a separate MO-TF form for each tax credit
transfer being requested. The sale or transfer of tax credits may have income tax consequences for the assignor and
assignee. Consult your tax advisor.
A
SSIGNOR
Name of Assignor
Federal ID No. (FEIN)
MITS/Missouri ID No.
SSN
Address
City
State
Zip Code
Contact Name
Title
Telephone Number
Fax Number
E-mail
T
RANSFER
Tax Credit Program
Approved Tax Benefit Number:
(Office use only) - AHAP New Tax Benefit
Number
Issued For the Calendar Year
or Tax Year Beginning
, Ending
.
Amount of Tax Credits Sold
Discount Rate
Sale Price
$
% $
$
% $
$
% $
Total Amount of Credits to Be Transferred
$
C
ERTIFICATION
•
I certify that I am an authorized representative of the Assignor and as such am authorized to make the statement of affirmation
contained herein.
•
I hereby agree to allow representatives of the Department of Economic Development access to the property and applicable
records as may be necessary for the administration of this program.
•
I certify under penalties of perjury that the above statements, information contained in this document and attachments are
complete, true, and correct to the best of my knowledge and belief.
Assignor Signature
Title
Print Name
Date
Notary Public Embosser Seal
Appeared before me this _________ day of _______________, 20____,
____________________________ to me personally known to be the person who
executed the above certification, and acknowledged and states on his/her oath to
me that he/she executed the same for the purpose therein stated.
State of
County (or City of St. Louis)
Notary Public Name
My
Use Rubber Stamp in Area Below
Commission
Expires
Notary Public Signature
10/05

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