Instructions For Application And Verification Form For Residential Energy Tax Credit (Page 4 of 4) in pdf

4. Pass-Through Option (Homeowner Completes)

 I want to keep the full tax credit myself

 I want to transfer my tax credit to  Oregon resident  Oregon business

• If your tax credit is $1,500 or less:

- Your pass-through partner will pay you 95% of the certified tax credit amount

- Your pass-through partner will receive 100% of the tax credit to be taken in one year

The Residential Energy Tax Credit Pass-through Option allows an individual, estate or trust subject to tax under ORS chapter 316

who purchases a qualifying device (a homeowner) to transfer their Residential Energy Tax Credit to another individual subject

to Oregon personal income tax under ORS 316 (a pass-through partner). You and your pass-through partner (the tax credit

recipient) will complete and sign the Pass-through Option Application and mail it to the Oregon Department of Energy. The

pass-through option is a one-time transfer and is final. The Department of Energy will then issue the tax credit certification to

the pass-through partner.

Important: There may be tax implications for the pass through partner. We advise you to consult with your tax preparer.

5. Declarations and Installation Verification

I understand that the Oregon Department of Energy does not make any warranty concerning the performance, operation,

installation or any other characteristic or feature of this stove. Energy Department approval is only for purposes of obtaining

the Oregon Residential Energy Tax Credit. I certify that I am the original owner of the stove. I certify that this stove is not

installed in a recreational vehicle or motor home. By signing below, I certify that the stove described in this application is

installed, that the stove replaced (if applicable) has been permanently removed from service, and that the information

contained herein is accurate and true.

The Oregon Department of Energy does not sell information from this application as a mailing list. However, we may be

required to disclose the name, address and phone number from your application under the Oregon Public Records law ORS

192.410 et seq. We can withhold your address and phone number following a written request explaining personal safety

concerns, such as a temporary restraining order. The Oregon Department of Energy does not endorse any company that

requests the information.

6. Applicant Signatures

You must sign below.

Signature of Applicant: ________________________________________Date _____________________

Signature of Joint Applicant: ____________________________________Date _____________________

Co Applicant:

Only if two or more persons are purchasing this system and filing separate tax returns,

give information below.

Name: ______________________ Address: ______________________________ % ownership: __________

Social Security Number:_________________Applicant Signature: ____________________Date: __________

7. Mailing Instructions

Before mailing, be sure your application is complete. It should include:

 Application form with your Social Security Number and signature

 Copy of itemized final receipt with full model numbers.

Photocopy all documents for your records and mail to the address below.

Oregon Department of Energy

625 Marion St. NE, Salem, Oregon

97301-3737

Toll-free: 1-800-221-8035

Salem: (503) 378-4040

Fax (503) 373-7806

Web site:

Note: The Oregon Department of Energy verifies the energy efficiency of stoves for the Oregon Residential Energy Tax Credit Program. It is the applicant’s

responsibility to ensure compliance with all other eligibility requirements. If you have questions concerning claiming the credit on your Oregon tax return,

contact the Oregon Department of Revenue at 1-800-356-4222 or (503) 378-4988.

05/15 ODOE CF-181