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                                                                                                                                 FORM NFC
                            Statement of Nebraska Financial Institution Tax Credit
                                                                                                                                 2022 
            Financial Institution’s Name and Mailing Address                  Shareholder’s Name and Mailing Address
  Name                                                              Name

  Street or Other Mailing Address                                   Street or Other Mailing Address

  City                                  State             Zip Code  City                                   State                 Zip Code

  Nebraska ID Number                    Federal ID Number           Social Security Number                 Spouse’s Social Security Number

  Taxable Year of Financial Institution                             Financial Institution Tax Credit (from Column I, 
  Beginning                       , 20  and Ending        , 20      Shareholder’s Schedule, Form 1120NF) .....................  $

                                        Provide this statement to the shareholder or beneficiary.
  Form NFC must be filed with the shareholder’s or beneficiary’s Nebraska Individual Income Tax Return, Form 1040N.
                                                   Please retain a copy for your records.
                                                             Instructions
       Who Completes the Form. Every financial institution electing to be taxed under the IRC as an S corporation must complete 
       a Statement of Nebraska Financial Institution Tax Credit, Form NFC, for each shareholder. If the financial institution is 
       owned by an S corporation bank holding company, attach a list of the shareholders of the holding company. If a trust owns 
       shares of the financial institution, attach a list of the beneficiaries of the trust. 
       This statement must be provided to each shareholder or beneficiary, as applicable. Do not file it with the Nebraska Financial 
       Institution Tax Return, Form 1120NF.        The individual shareholder or beneficiary must attach this statement to his or her 
       Nebraska individual income tax return to claim the credit. If the shares are jointly owned by spouses, then one Form NFC 
       may be completed for both spouses.
       If shares are owned separately by spouses filing a married, filing jointly return, separate Forms NFC must be issued to each 
       owner reflecting each spouse’s proportionate share of the credit. 
       Amount of Credit.                Enter the individual shareholder’s or beneficiary’s amount of calculated credit from Column I, 
       Shareholder’s Schedule, Form 1120NF. Do not enter the total amount of the tax paid by the financial institution.
       Shareholder or Beneficiary.      See the “Credit for Financial Institution Tax” section of the instructions for the Nebraska 
       Individual Income Tax Return, Form 1040N.

                                                                                                                                          8-632-2022