Form 527-A - Small Business Capital Company Report For Investors - 2010
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3Barcode Placement
State of Oklahoma
Small Business Capital Company
527-A
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Report for Investors
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The Small Business Capital Company must file Form 527 before this credit will be allowed.
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A copy of this form must be enclosed with the investor’s income tax return if the credit is claimed.
This form must be furnished to the investor by January 31st. See instructions for further information.
Identification Number ______________________________
Identification Number ______________________________
Name of Investor _________________________________
Name of Small Business Capital Company:
Address _________________________________________
________________________________________________
City _______________________ State _____ Zip _______
Address _________________________________________
City _______________________ State _____ Zip _______
See Tax Credit Moratorium on page 2.
Telephone Number ________________________________
Part 1:
Establishing the Small Business Capital Credit
(4)
(1)
(2)
(3)
Date
Total Investment in,
Credit Allowable
of
or in conjunction with, the
Total Credit Available
in 2010 on investments
Investment
Small Business Capital Company
(Column 2 x 20%)
made prior to June 1, 2010
Total Credit Allowable in 2010
Carry the credit claimed this year to Form 511CR. If the entire credit is not being claimed this year, complete Part 2 for the subsequent carryover years.
Under penalties of perjury, I declare that I have examined this return, including accompanying statements, and to the best of my knowledge and belief it
is true, accurate and complete.
Officer, General Partner or Member of the Small Business Capital Company: __________________________________________ Date: ___________
Part 2:
2010 Credit Carryover
1.
Total credit allowable in 2010 ............................................................................... 1.
2.
Credits used in prior years:
Year
Amount
2010
(a)
$
(b)
2011
$
(c)
2012
$
Total credits used prior to this year . ......................................................... 2.
3.
Unused credit available (line 1 less line 2) ........................................................... 3.
4.
Credit claimed this year, _____ (carry to Form 511CR) ...................................... 4.
5.
Unused balance carryover (line 3 less line 4) (three year carryover limit) . ........... 5.
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