R -10611 (1/16)

                               Motion Picture Investment Tax Credit Schedule
                               *Pursuant to the Provisions of Louisiana
                               Revised Statue 47:6007

                                                                                                                                                                PLEASE PRINT OR TYPE.
Taxpayer Name                                                          LDR Account ID                                                                           Filing Period (mm/dd/yyyy)

                                            LDR  
                                            Account                                                                                                             Credits 
                                            ID of                                                                                                   Credits     Claimed on    Remaining 
State Certification Production Transferring Transferring  Date of           Credits   Credits Credits Sold                                          Claimed in  Current       Credit  
Number              Name       Entity       Entity   Transfer               Purchased Sold                                                 to State Prior Years Year Return   Balance

*  All statutory requirements must have been met and all appropriate documentation must have been provided to the Louisiana Department of Revenue in a timely manner including but not limited to 
the certification letter issued by the Louisiana Department of Economic Development and letters documenting any subsequent transfer of such credits. Failure to provide such documentation in an  
appropriate and timely manner will result in the disallowance of any credits claimed. See RIB 05-001 and 15-033 for additional information.