STATE OF RHODE ISLAND 
                                                            DIVISION OF TAXATION 
                                                             ONE CAPITOL HILL 
                                                            PROVIDENCE, RI 02908

                                                             Form TC-100
                     Tax Credits and Incentives Disclosure Form

 Name of recipient

 Address

City                                                                   State                              ZIP code     

Social security number or federal identification number

 Rhode Island law requires entities receiving specific tax credits and incentives disclose certain information 
 to the Division of Taxation.  The Act affects all entities using the following tax credits and incentives:
     Rhode Island Economic Development Corporation Project Status - § 42-64-10
 .
     Incentives for Innovation and Growth - § 44-63
 .
     Jobs Development Act - § 42-64.5
 .
     Distressed Areas Economic Revitalization Act - Enterprise Zones - § 42-64.3
 .
     Motion Picture Production Tax Credits - § 44-31.2
 .
     Historic Preservation Tax Credits 2013 - § 44-33.6
 .
 Please complete the section below detailing the tax credits and/or incentives you either received or claimed 
 during the tax year ending 6/30/2024.

 Name of Governmental Entity, State Agency or Public Agency   Description of Credit/Incentive
           Source of Credit/Incentive                                                        Amount of Credit/Incentive

                     If additional space is needed, please attach a separate sheet with the additional information.

This disclosure form must be filed with the Division of Taxation on or before August 15, 2024.

 Under penalties of perjury, I declare that I have examined this return, and to the best of my knowledge and belief, it is true, correct and complete.
Signature                                                                Title                   Date

Print name                                                                       Telephone number
                                                                                 (     )
If you have further questions or need assistance, please contact Donna Dube at (401) 574-8903. 
 
           Mail completed form to: RI Division of Taxation 
                                      Forms, Credits & Incentives Section 
                                      One Capitol Hill 
                                      Providence, RI 02908 
                                      Attn: Donna Dube