STATE  OF                         HODER      ISLAND                                              
                                                  DIVISION                          OF AXATIONT                                                        2013
                                                       ONE                     CAPITOL         HILL
                                                  PROVIDENCE, RI                            02908                                                  Form HTC-13

            Application for Rhode Island Historic Preservation Tax Credits 2013
Pursuant to R.I.G.L. 44-33.6 application may be made to the Rhode Island Division of Taxation beginning on August 1,
2013 to reserve a portion of the credit available under the Rhode Island Historical Preservation Tax Credits 2013 program.  

Applicant Information:
Applicant name                                                                             Social security number or federal identification number

Applicant address

City                                  State                                         ZIP Code

Mailing address, if different from above (All correspondence will be sent using this address.)

City                                  State                                         ZIP Code

                                                                                                                            If other, describe:
What is your relationship to this project?  Owner                                   Developer              Other
Contact name                                                                               Contact telephone number

Contact email address

Project Information:
Project name

Project address

Project number (if already issued - if not leave blank)

Has this project already been issued a Part 1 Certification?                           YES         NO    If yes, when?

Will this be a phased project?    YES                  NO

Estimated amount of qualified rehabilitation expenditures to be incurred

Estimated amount of historic preservation tax credit 2013 (not to exceed $5,000,000)
Are you applying for a 20% or 25% credit?                            20%       25%  To qualify for the 25% credit, at least 25% of the total rentable area, or
the entire first floor, of the certified historic structure will be made available for a trade or business as defined under RIGL chapter 44-33.6.
Signature of applicant                                                                     Date

Signature of owner (REQUIRED if applicant is not owner of property)                                                                                Date

By signing this application, you authorize the Rhode Island Division of Taxation to share information contained
on this application with the Rhode Island Historical Preservation & Heritage Commission.  

For further questions or assistance, please contact Donna Dube at (401) 574-8903

Mail completed applications to: Donna Dube
                                RI Division of Taxation
                                Forms, Credits & Incentives Section
                                One Capitol Hill
                                Providence, RI 02908