0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80 1 1 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 51 0 0 0 4 4 4 4 0 Department Use Only 0 0 0 5 5 5 5 0 Form (MM/DD/YY) 0 0 0 6 6 6 6 0 MO-TF Missouri Tax Credit Transfer Form 0 0 0 7 7 7 7 0 0 0 0 8 8 8 8 0 0 0 0 9 9 9 9 0 Assignor Assignor 1 1 1 0 0 0 0 1 Missouri Tax I.D. Federal Employer 1 1 1 1 1 1 1 1 Number I.D. Number 1 1 1 2 2 2 2 1 Assignor 1 1 1 3 3 3 3 1 Social Security 1 1 1 4 4 4 4 1 Number 1 1 1 5 5 5 5 1 1 1 1 6 6 6 6 1 Name 1 1 1 7 7 7 7 1 1 1 1 8 8 8 8 1 Contact Person Title 1 1 1 9 9 9 9 1 2 2 2 0 0 0 0 2 Address City State ZIP Code 2 2 2 1 1 1 1 2 Assignor 2 2 2 2 2 2 2 2 Telephone Number Fax Number E-mail 2 2 2 3 3 3 3 2 2 2 2 4 4 4 4 2 (___ ___ ___) ___ ___ ___- ___ ___ ___ ___ (___ ___ ___) ___ ___ ___-___ ___ ___ ___ 2 2 2 5 5 5 5 2 The Missouri Tax Credit Transfer Form (MO-TF) must be used when transferring any transferable Missouri tax credits listed on page 2. 2 2 2 6 6 6 6 2 Submit a separate Form MO-TF for each tax credit transfer. 2 2 2 7 7 7 7 2 2 2 2 8 8 8 8 2 Tax Credit Program Approved Tax Benefit Number 2 2 2 9 9 9 9 2 3 3 3 0 0 0 0 3 3 3 3 1 1 1 1 3 Issued For the Calendar Year ____________ or Tax Year Beginning __________________________, Ending __________________________. 3 3 3 2 2 2 2 3 Amount of Tax Credits Sold Discount Rate Sale Price 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 3 Transfer $ % $ 3 3 3 5 5 5 5 3 $ % $ 3 3 3 6 6 6 6 3 3 3 3 7 7 7 7 3 $ % $ 3 3 3 8 8 8 8 3 Total amount of credits to be transferred..................................... $ 3 3 3 9 9 9 9 3 4 4 4 0 0 0 0 4 Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. I also certify that I am 4 4 4 1 1 1 1 4 an authorized representative of the Assignor and I am authorized to make the statement of affirmation contained herein. 4 4 4 2 2 2 2 4 Assignor Signature Title 4 4 4 3 3 3 3 4 4 4 4 4 4 4 4 4 Certification Print Name Date (MM/DD/YYYY) 4 4 4 5 5 5 5 4 ___ ___ / ___ ___ / ___ ___ ___ ___ 4 4 4 6 6 6 6 4 4 4 4 7 7 7 7 4 4 4 4 8 8 8 8 4 Embosser or black ink rubber stamp seal Subscribed and sworn before me, this 4 4 4 9 9 9 9 4 day of year 4 4 4 0 0 0 0 4 State County (or City of St. Louis) My Commission Expires (MM/DD/YYYY) 5 5 5 1 1 1 1 5 __ __ /__ __ /__ __ __ __ 5 5 5 2 2 2 2 5 5 5 5 3 3 3 3 5 Notary Public Signature 5 5 5 4 4 4 4 5 5 5 5 5 5 5 5 5 Notary Information Notary Public Name (Typed or Printed) 5 5 5 6 6 6 6 5 5 5 5 7 7 7 7 5 5 5 5 8 8 8 8 5 5 5 5 9 9 9 9 5 5 5 5 0 0 0 0 5 6 6 6 1 1 1 1 6 6 6 6 2 2 2 2 6 *14305010001* 6 6 6 3 3 3 3 6 14305010001 6 6 6 4 4 4 4 6 6 6 6 5 5 5 5 6 6 6 666 6 6 6 |
Name Federal Employer I.D. Number (FEIN) Missouri Tax I.D. Number Social Security Number | | | | | | | | | | | | | | | | | | | | | | | Contact Person Title Assignee Address City State ZIP Code Telephone Number Fax Number E-mail (___ ___ ___) ___ ___ ___- ___ ___ ___ ___ (___ ___ ___) ___ ___ ___-___ ___ ___ ___ Select One r C Corporation r Financial Institution r Individual r Individual Filing a Joint Return r Limited Liability Company (LLC) r S Corporation r Partnership r Sole Proprietor r Other __________________________________________________ If the taxpayer is an individual filing a joint return, list the primary and secondary names and social security numbers below. If the taxpayer is a Partnership, S Corporation, or other entity with a flow through tax treatment, identify the names, social security numbers, and proportionate share of ownership of each beneficiary, partner, or shareholder on the last day of the tax period. Aggregate proportionate shares or percent of total ownership must be less than 100%. Attach a separate sheet if necessary. Assignee Type Name(s) Federal Employer I.D. Number, Missouri Tax % Ownership Year End I.D. Number, or Social Security Number | | | | | | | | % | | | | | | | | % | | | | | | | | % Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. I certify that I am an authorized representative of the Assignee and as such am authorized to make the statement of affirmation contained herein. Assignee Signature Title Certification Print Name Date (MM/DD/YYYY) ___ ___ / ___ ___ / ___ ___ ___ ___ Embosser or black ink rubber stamp seal Subscribed and sworn before me, this day of year State County (or City of St. Louis) My Commission Expires (MM/DD/YYYY) __ __ /__ __ /__ __ __ __ Notary Public Signature Notary Information Notary Public Name (Typed or Printed) *14305020001* 14305020001 |