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                                           (SU) 06-22 (FI)
                   REV-774 
                                                                        ASSIGNMENT OF 
                                                                                   TAX CREDIT

                   This notice is to authorize the assignment of tax credit(s). DO NOT SUBMIT WITH TAX REPORT
 From Assignor (holder of the credit):
START Name of Owner (Individual, Partnership, Corporation, etc.)                                    Federal Employer Identification Number (FEIN) 
Ü
 Trade Name (If other than preceding line)                                                          Type of Tax (Sales, Corporation, etc.) 

 Street Address                                                    City            State        ZIP Revenue ID Number

      TYPE OF TAX AND IDENTIFICATION NUMBER                             MONTH/YEAR OR TAX NOTICE NUMBER           AMOUNT TO BE CREDITED

 To Assignee (receiver of credit):
 Name of Owner (Individual, Partnership, Corporation, etc.)                                         Federal Employer Identification Number (FEIN) 

 Trade Name (If other than preceding line)                                                          Type of Tax (Sales, Corporation, etc.) 

 Street Address                                                    City            State        ZIP Revenue ID Number

      TYPE OF TAX AND IDENTIFICATION NUMBER                             MONTH/YEAR OR TAX NOTICE NUMBER           AMOUNT TO BE CREDITED

 For value received, the above-named assignor sells, transfers and assigns to the assignee, the credit(s) listed above.
                   DAY                                                  MONTH, YYYY
 Signed this                                                day of                 . 
 If Proprietorship or Partnership:                                                 If Corporation: 
 Signature                                                                         Signature of Corporate Officer 
                   Please Sign after printing.                                                      Please Sign after printing.
 Signature                                                                         Officer Title 
                   Please Sign after printing.
 Telphone Number                                                                   Telephone Number

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                                  Instructions for Form REV-774 
REV-774 IN (SU) 06-22                                                                        Assignment of Tax Credit

                                                                    In the case of a partnership assigning credit, the signatures of 
       GENERAL INFORMATION                                          all partners are required (attach a separate schedule if necessary). 

Assignments are the transfer of available credit between business   For corporations, the signature of a corporate officer is required. 
entities. Credit is available for assignment to the extent that the 
credit exceeds the debits owed the commonwealth by the assignor.    For more information,  email RA-CORP_ACC_FAX@PA.GOV 
The application for assignment authorizes the Department of         or call 800-447-3020 (services for taxpayers with special hearing 
Revenue to transfer available credit as an offset to debits within  and/or speaking needs).  
the account releasing the credit. 
                                                                    Submit forms to RA-CORP_ACC_FAX@PA.GOV. 
Credits may be used as payment of any commonwealth tax 
obligation administered by the Department of Revenue other than     NOTE: DO NOT SUBMIT WITH TAX REPORT
a Motor License Fund obligation. 

Assignments/Transfers will be applied as of the date of the 
payment that created the credit.

www.revenue.pa.gov                                                                                                REV-774 1
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