MISSOURI FORM CDTC-770              

                      MISSOURI DEPARTMENT OF ECONOMIC DEVELOPMENT                                                                                                                    BENEFIT NUMBER - OFFICE USE ONLY                               
                      APPLICATION FOR CLAIMING TAX CREDITS
This application is to be completed by the taxpayer/donor for which a tax credit will be issued.  Instructions for completing this form are on the reverse.  Please 
type or print.
PART I:  QUALIFYING PROGRAM
      FAMILY DEVELOPMENT ACCOUNT                 NEIGHBORHOOD ASSISTANCE PROGRAM                   YOUTH OPPORTUNITIES PROGRAM
PART II:  TAXPAYER (DONOR) INFORMATION - See instructions.
TAXPAYER NAME - INDIVIDUAL (INCLUDE SPOUSE INFORMATION IF A JOINT RETURN IS FILED) OR BUSINESS NAME (AS LISTED WITH SECRETARY OF STATE'S OFFICE)

FOR BUSINESSES, LIST A CONTACT PERSON                                                                       CONTACT EMAIL ADDRESS                            CONTACT TELEPHONE #

MAILING ADDRESS                                                                                             CITY                                             STATE ZIP CODE

SOCIAL SECURITY NUMBER                    SPOUSE SOCIAL SECURITY NUMBER                                                                BUSINESS FEDERAL ID NUMBER  MISSOURI TAX ID NUMBER

TAXES PAID BY:
      □ CALENDAR YEAR    OR      □ FISCAL YEAR FROM  __________________ TO __________________
PART III:  TAXPAYER ELIGIBILITY - CHOOSE ONLY ONE ELIGIBILITY STATUS  
INDIVIDUAL DONOR                                                                                                    BUSINESS DONOR
□ INDIVIDUAL - YOP AND FDA ONLY                                                                                     □  CORPORATION
  □ INDIVIDUAL WITH A FARM OPERATION                                                                                □  FINANCIAL INSTITUTION
  □ INDIVIDUAL REPORTING INCOME FROM MO RENTAL                                                                      □  PARTNERSHIP - ATTACH PARTNER NAMES, SOCIAL SECURITY 
     PROPERTY OR ROYALTIES                                                                                                NUMBERS, AND PERCENTS OF OWNERSHIP
□ INDIVIDUAL REPORTING INCOME FROM A SOLE                                                                           □  S-CORPORATION - ATTACH SHAREHOLDER NAMES, SOCIAL
     PROPRIETORSHIP                                                                                                       SECURITY NUMBERS, AND PERCENTS OF OWNERSHIP
□ INDIVIDUAL REPORTING INCOME FROM A PARTNERSHIP,                                                                   □  LIMITED LIABILITY CORP - ATTACH MEMBER NAMES, SOCIAL
     S-CORPORATION, OR LIMITED LIABILITY CORP (LLC)                                                                       SECURITY NUMBERS, AND PERCENTS OF OWNERSHIP
                                                                                                                    □  INSURANCE COMPANY
PART IV:  TYPE OF CONTRIBUTION AND VALUE
                                      TYPE OF CONTRIBUTION                                                                                                   VALUE DATE OF CONTRIBUTION 
                                                                                                                                                                                          MONTH/DAY/YEAR
□  CASH;  WERE ANY GOODS AND/OR SERVICES RECEIVED?                                                     □ YES      □ NO
□  STOCKS (VALUED BETWEEN HIGH AND LOW ON THE DATE OF TRANSFER FROM DONOR
     INTO NONPROFIT'S BROKERAGE ACCOUNT)
□  IN-KIND (VALUED AS  LESSER OF COST TO DONOR OR FAIR MARKET VALUE)
□  WAGES PAID TO PARTICIPATING YOUTH - YOP ONLY
PART V:  TAXPAYER CERTIFICATION AND NOTARIZATION (TO BE SIGNED IN NOTARY'S PRESENCE)
I have examined the above application and confirm, to the best of my knowledge, information, and 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 law (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 years following any such finding.  
TAXPAYER SIGNATURE

NOTARY PUBLIC EMBOSSER OR BLANK INK RUBBER                                                    STATE                                                          COUNTY (OR CITY OF ST. LOUIS)
STAMP SEAL 
                                          SUBSCRIBED AND SWORN BEFORE ME, THIS                                                                               USE RUBBER STAMP IN CLEAR AREA BELOW
                                                                DAY OF                                                             YEAR
                                          NOTARY PUBLIC SIGNATURE                                                                      MY COMMISSION EXPIRES:

                                          NOTARY PUBLIC NAME TYPED OR PRINTED

PART VI:  CONTRIBUTION VERIFICATION BY PROJECT DIRECTOR
APPROVED ORGANIZATION NAME                                                                                                             PROJECT NUMBER

I have examined this application and 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.
PROJECT DIRECTOR NAME PRINTED/TYPED                                                                 PROJECT DIRECTOR SIGNATURE                                     DATE

                 THIS FORM MUST BE SUBMITTED TO DED WITHIN 12 MONTHS FROM THE DATE OF DONATION TO QUALIFY FOR A TAX CREDIT.
(03/2014)

INSTRUCTIONS FOR COMPLETING MISSOURI FORM CDTC-770
This application form is used to claim credits for eligible contributions made by individuals and businesses to organizations approved for the 
Neighborhood Assistance (NAP), Youth Opportunities (YOP), or Family Development Account (FDA) Programs.  ALLOW 3-6 WEEKS FOR PROCESSING.  
DONOR AND PROJECT  DIRECTOR SIGNATURES, AS WELL AS NOTARY, MUST BE ORIGINALS (NO COPIES).
TAXPAYER/DONOR COMPLETES & ATTACHES DONATION DOCUMENTATION
PART I:  SELECT ONLY ONE PROGRAM TYPE
PART II:  DONOR'S/TAXPAYER'S FULL NAME, ADDRESS, IDENTIFICATION NUMBERS
  INDIVIDUALS and INDIVIDUALS with BUSINESS INCOME - Enter donor name, social security number, and contact information.  IF MARRIED FILING A 
JOINT TAX RETURN,  enter donor name AND spouse's name AND both social security numbers.
BUSINESS DONORS - Enter full business name as registered with Secretary of State; Provide the name, email, and phone number of the business 
contact in the event DED staff have questions. Enter Federal ID Number.
  Enter the address the tax credit certificate should be mailed to.
  Indicate whether taxes are paid by calendar year or fiscal year.   If fiscal year, enter dates.
PART III:  TAXPAYER ELIGIBILITY - CHOOSE ONLY ONE ELIGIBILITY STATUS  
Select ONE (1) taxpayer status that qualifies you to receive a tax credit.   You must check the box that describes the donor's tax status at the time the 
contribution was made.  
  YOP and FDA are the only programs for which the Individual box may be checked. 
  Donations to be claimed by a business entity (with the exception of sole proprietorships) MUST be made from a business account.  
  Partnerships, S-Corps, and LLC's are required to attach:  a complete list of partners, shareholders, or members, their social security numbers, and 
percents of ownership by each.  Note:  Percent of profit distribution is not always the same as percent of ownership.  If any partners, shareholders, or 
members are trusts, include both the Federal ID number for the trust and social security number of the beneficiary.
PART IV: TYPE OF CONTRIBUTION/DONATION MADE AND VALUE; PROOF OF DONATION 
CASH/MONETARY DONATIONS:   
Checks - Attach documentation that clearly shows the check has cleared the DONOR's bank account.  ALL pages of documentation must include donor 
name and/or account number. Traditional Documentation:  1) A copy of the front of the check and the donor's checking account statement showing the 
check's posting; 2) A copy of the front and back of the check, along with proof of posting to the donor's bank, such as a letter from the bank or other 
bank transaction showing the check #, check amount, and post date.  Online Banking Documentation:  1) Printout (microfiche) of front of the check, 
with post date, check #, and amount; 2) Printout of front and back of the check, with "dda debits" or web address of donor's financial institution at the 
top or bottom of the printout. 
Credit Card - Credit card statement must show donor's name and last 4 digits of the account number, as well as:  billing cycle, date the charge was 
posted, name of the recipient organization, and amount of donation.
Electronic Funds Transfer/Debit - Donor provides a copy of their bank statement showing EFT or ACH, including donor name and last 4 digits of the 
account number, statement date, transaction date, recipient organization, and amount of donation.
STOCK DONATIONS:  
Must show donor ownership of stock, transfer of stock to the organization, and sale of the stock by the organization.
Donor/taxpayer must provide  a letter from their broker OR a copy of their brokerage account portfolio showing:  donor name, name of recipient 
organization, name of security(ies) transferred from donor account to organization, number of shares, and date of transfer.
Recipient organization must provide proof the donated stock was sold.  Attach a copy of the brokerage statement showing sale of stock (name of 
security(ies) sold, number of shares, date sold, amount) OR trade confirmation AND a copy of the front of the brokerage check or proof of payment from 
the stock sale.
IN-KIND DONATIONS:  
Real estate contributions – Attach a copy of the deed, the required number of appraisals, and a Phase I Environmental Assessment.  At least two 
qualified, independent appraisals are required for real or personal property contributions.  Exceptions:  Commercial property valued at less than fifty 
thousand dollars and vacant or residential property with a value of less than twenty-five thousand dollars require only one appraisal.  State licensed or 
certified appraisers must perform all appraisals.  
Rent donations - Valued at comparable market value of the rental OR the actual rental value, whichever is less.  Attach an invoice from the lessor to 
the lessee AND a letter from an independent appraiser stating the value of comparable rents for the area.
Equipment/Supplies – Attach a copy of the invoice showing the cost to the donor or current fair market value, whichever is less.
Professional services (NAP ONLY) – Attach a copy of the invoice or other documentation showing the cost of services to the donor or fair market 
value, whichever is less.  Include the type of services being donated, number of hours, and rate.
WAGES PAID (YOP ONLY) - Attach a copy of the employer's payroll record, the Wages Paid Statement, and the Employee Pay History (available online).  
The Wages Paid Statement should:  be signed by the employee and the employer, itemize the total number of hours worked (regular and overtime), and 
list the employee’s hourly wages.  
PART V:  DONOR SIGNATURE AND NOTARY
Donor must sign the form in the presence of a notary.  The form and documentation/proof of the donation should be returned to the NAP/YOP/FDA 
approved organization.  The tax credit cannot be claimed on the Missouri tax return until the donor has received an official tax credit Certificate from 
the Department of Economic Development.
 
PROJECT DIRECTOR OF THE APPROVED ORGANIZATION
PART VI:  CONTRIBUTION VERIFICATION BY PROJECT DIRECTOR
Enter name of the organization, project number assigned by DED, and printed Project Director name.  VERIFY AND ATTACH ALL REQUIRED 
DOCUMENTATION.  Sign and date the form, then forward, with documentation, to DED for processing.  Mail to:  NAP/YOP/FDA, MO Department of 
Economic Development, PO Box 118, Jefferson City, MO, 65102.
Need examples of acceptable documentation? Questions? Call (573) 522-2629 or (573) 751-4539