APPLICATION FOR CLAIMING TAX CREDITS                                                    Missouri Form CDTC-770

This application is to be completed by the taxpayer/donor for which the tax credit will be issued.  Instructions for completing this form are on pg. 2.  Please type or 
print.  Tax credit applications must be turned in to the Department of Economic Development (DED) no later than 1-year after the donation date.   
1.    QUALIFYING PROGRAM
     Youth Opportunities                    Neighborhood Assistance              Small Business Incubator Tax               Family Development Account
      (YOP)                                   (NAP)                                 Credit (SBI)                                (FDA) 
2.    TAXPAYER (DONOR) MAILING ADDRESS
Street Address                                                        City                                               State        Zip Code 

3.    TAXPAYER (DONOR) INFORMATION
Individual Donors (complete the fields below)                                 Business Donors (complete the fields below) 
Taxpayer Name                                      Taxpayer Social Security # Business Name (as listed with SOS)                      Business Federal ID (FEIN) 

Spouse Name (joint tax return filers only)         Spouse Social Security #   Business Contact Name 

Taxpayer Email                                     Taxpayer Phone             Business Contact Email                                  Business Contact Phone 

Taxpayer status at the time the donation was made (select only 1)             Business status at the time the donation was made (select only 1) 
     Individual – YOP, SBI, and FDA programs only                                 Corporation
     Individual - with a farm operation                                           Financial Institution 
     Individual - reporting income from MO rental properties or royalties         Partnership - attach partner names, social security #’s, and percents of  
     Individual - reporting income from a sole proprietorship                      ownership.
     Individual - reporting income from a partnership, S-Corporation or           S-Corporation - attach shareholder names, social security #’s, and pe
      Limited Liability Corp. (LLC)                                                 percents of ownership. 
                                                                                   Limited Liability Corp. - attach members names, social security #’s, and 
                                                                                    percents of ownership. 
                                                                                   Insurance company
Taxes paid by:                                                                Taxes paid by: 
     Calendar Year (CY)                                                           Calendar Year (CY)          Fiscal Year (FY)  From_______     To________
4.    TYPE OF CONTRIBUTION AND VALUE 
Were any goods and/or services received?        Required             Yes      No     Contribution includes payment processing fee(s)              
Type of Contribution                                                          Eligible Contribution Value                Date of Contribution (MM/DD/YYYY) 
Cash 
Stocks (valued between high/low on the date of transfer from the donor into 
the nonprofit’s brokerage account) 
In-Kind (valued as the lesser of the cost to donor OR fair market value) 
Wages Paid to participating youth (YOP program only) 
Total Eligible Contribution Value (Amt Eligible for YOP/NAP/SBI/FDA Program)  $ 0.00
5.    CONTRIBUTION DOCUMENTATION
     I have attached the required documentation per the type of contribution listed in the Companion Guide.
6.    TAXPAYER CERTIFICATION AND NOTARIZATION (TO BE SIGNED IN A NOTARY’S PRESENCE)
I have examined the above application and confirm, to the best of my knowledge, information, & belief, that the above information is true and correct.  Further, 
if operating as a business in Missouri, I declare that I do not knowingly employ illegal aliens and have complied with federal laws (8 U.S.C. 1324A), which requires 
examination of the appropriate documents to verify employment eligibility.  I understand that if found to have employed an illegal alien in Missouri and did not, 
for that employee, examine the documents required by federal law, that I shall be ineligible for any state-administered or subsidized tax credit, tax abatement, or 
loan for a period of five (5) years following such finding.  
Taxpayer Signature 

Notary public rubber stamp seal     State                                                         County (or City of St. Louis) 

                                    Subscribed and sworn before me, this 
                                    Day                                       Month                                    Year 

                                    Notary public name                        Notary public signature                  My commission expires (MM/DD/YYYY)

7.    CONTRIBUTION VERIFICATION BY PROJECT DIRECTOR
Approved Organization Name                                                                                               Project Number 

I have examined this application including all attachments and believe it to be an accurate description of the contribution received by our organization for the 
purpose of carrying out the approved project.   
Authorized Signer Name (printed/typed)                                Authorized Signer Signature                        Date (MM/DD/YYYY) 

Rev. 4/24 

GENERAL NOTES: 
•         Please allow 3-6 weeks for processing of this application.
•         The tax credit cannot be claimed on a Missouri tax return until the donor has received the official tax credit certificate
          from the Missouri Department of Economic Development (DED).
•         Reach out to DED at community@ded.mo.gov or 573-522-4216 with any questions about completing this form.
1. QUALIFYING PROGRAM
•         Select the applicable program type.
•         Note: Please make only 1 selection.
2. TAXPAYER (DONOR) MAILING ADDRESS
•         Enter the mailing address for the taxpayer.
3. TAXPAYER (DONOR) INFORMATION
•         Please complete the required fields for either individuals (and individuals with business income) OR business donors.
•         Indicate whether taxes are paid by Calendar Year (CY) or Fiscal Year (FY).
          1)  If taxes are paid by Fiscal Year, enter the start and end dates of the Fiscal Year.
•         Note: Donations claimed by a business entity (except for sole proprietorships) must be made from a business account.
•         Attachments: Partnerships, S-Corps, & LLCs are required to attach:
          1)  A complete list of partners, shareholders, or members,
          2)  The social security numbers of all partners, shareholders, or members AND,
          3)  Percents of ownership by each partner, shareholder, or member. Note: Percent of profit distribution is not
              always the same as percent of ownership.  If any partners, shareholders, or members are trusts, include both 1)
              the Federal ID number for the trust AND 2) the social security number of the beneficiary.
4. TYPE OF CONTRIBUTION AND VALUE
•         Indicate whether any goods and/or services were received using the checkboxes.
•         Indicate the type, total eligible contribution value, and date of the contribution.
5. CONTRIBUTION DOCUMENTATION
•         Attachments: All applications for tax credits must include documentation demonstrating proof of the donation as
          described in the Companion Guide.
•         Please check the box confirming that you have provided the required documentation.
6. TAXPAYER CERTIFICATION AND NOTARIZATION
•         The taxpayer/business (donor) must sign the form in the presence of a notary.
•         The form and documentation should then be returned to the approved organization.
7. CONTRIBUTION VERIFICATION BY PROJECT DIRECTOR
•         Verify all information on the form to ensure accuracy and completeness.
•         Attach all required documentation - see instructions above and in the Companion Guide.
•         An authorized signer for the approved organization must sign and date the form.
SUBMITTING THIS FORM:  
•         Send Via FTP Portal (Recommended):
          1)  The FTP portal is a file system that allows users to send large documents that are too big to go through email.
          2)  To upload a file, please follow the instructions on the NAP webpage or YOP webpage under the “How Do I
              Apply” tab.
          3)  Note: A notification email confirming receipt will be sent to the authorized signer within 3 business days.
•         Send Via Email (alternative option for smaller file size submissions)
•         Note: Program documents can be accepted as either digital OR original documents. If you choose to mail an original
          document, please do not upload a duplicate. Likewise, please do not mail an original copy if you have uploaded the
          same file through the webpage.  Any original documents should be mailed to the address listed below.
          1)  NAP/YOP/FDA
              MO Department of Economic Development
              PO Box 118
              Jefferson City, MO 65102

Rev. 4/24