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Form LOA Instructions
What is the Loan-Out Affidavit? Payments to Personal Service/Loan-out
The Loan-Out Affidavit is a form the production company is required Companies
to complete and submit for each and every personal service/loan- To be completed by the production company.
out company whose wages are included on the Film Credit Applica-
tion. Failure by the production company to complete and submit a Line 1
Loan-Out Affidavit for a personal service/loan-out company will re- Enter the total amount of wages paid to the personal service/loan-
sult in disallowance of the credit claimed in relation to such per- out company for the production everywhere.
sonal service/loan-out company. Line 2
Note: The affidavit must be completed in full and signed with origi- Enter the total amount of qualified wages paid to the personal serv-
nal signatures by an authorized representative of the production ice/loan-out company for the production in Massachusetts.
company, an authorized representative of the personal service/ Line 3
loan-out company and the actor/performer in order to be valid and
Fill in to verify that all wages paid to the personal service/ loan-out
accepted.
company are for services performed in Massachusetts and consti-
Who Must File a Loan-Out Affidavit? tute Massachusetts source income to the personal service/loan-out
Production companies who are claiming wages for amounts paid to company.
personal service/loan-out companies on the Massachusetts Appli- Line 4
cation for Payroll/Production Credit must file the affidavit with their Under 830 CMR 62B.2.3, the production company is required to
application for credit. A separate Loan-Out Affidavit must be com- register and withhold on payments made to loan-out companies.
pleted and filed with the Massachusetts Application for Payroll/Pro- Fill in to verify that the production company has complied with the
duction Credit for each personal service/loan-out company included regulation.
on the application for credit.
Line 5
Note: A copy of the signed affidavit should be retained by the loan-
Enter the total amount of Massachusetts withholding tax remitted to
out company and the actor/performer for their records and to attach
Massachusetts relating to the wages paid to this loan-out company.
to their Massachusetts income tax returns as required.
Line 6
General Information
Enter the range of dates that this loan-out company performed serv-
Complete the general information section of this application with the
ices in Massachusetts relating to the wages on line 2.
information requested. On the Massachusetts production informa-
tion line, enter the first date that the production company did work in Line 7
Massachusetts and the final day the production company did work Enter the date or dates withholding tax payments were made to
in Massachusetts on this production. Massachusetts.
Personal Service/Loan-out Company Information Note: The completed form must be filed with the Application for Pay-
This section is to be completed and signed by an authorized repre- roll/Production Credit.
sentative of the personal service/loan-out company. All sections
must be completed in order for the wages to be included on the pro- Mail to Massachusetts Department of Revenue, Audit Division,
duction company’s credit application. The Massachusetts start and 200 Arlington Street, Room 4300, Chelsea, MA 02150, attn. Film
end dates are the first date that the personal service/loan-out com - Credit Unit.
pany did work in Massachusetts and the final day the personal serv-
ice/loan-out company did work in Massachusetts on this production.
Actor/Performer Information
This section is to be completed and signed by the actor/performer.
All sections must be completed in order for the wages to be included
on the production company’s credit application. The Massachusetts
start and end dates are the first date that the actor/performer did
work in Massachusetts and the final day the actor/performer did
work in Massachusetts on this production.
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