Form Mo-Tf - Missouri Tax Credit Transfer Form - 2014
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Department Use Only
Missouri Department of Revenue
(MM/DD/YY)
Form
Missouri Tax Credit Transfer Form
MO-TF
Assignor
Assignor
Missouri Tax I.D.
Federal Employer
Number
I.D. Number
Assignor
Social Security
Number
Name
Contact Person
Title
Address
City
State
ZIP Code
Telephone Number
Fax Number
E-mail
(___ ___ ___)___ ___ ___-___ ___ ___ ___
(___ ___ ___)___ ___ ___-___ ___ ___ ___
The Missouri Tax Credit Transfer Form (MO-TF) must be used when transferring any transferable Missouri tax credits listed on page 2.
Submit a separate Form MO-TF for each tax credit transfer.
Tax Credit Program
Approved Tax Benefit Number
Issued For the Calendar Year ____________ or Tax Year Beginning __________________________, Ending __________________________.
Amount of Tax Credits Sold
Discount Rate
Sale Price
$
%
$
$
%
$
$
%
$
Total amount of credits to be transferred.....................................
$
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
an authorized representative of the Assignor and I am authorized to make the statement of affirmation contained herein.
Assignor Signature
Title
Print Name
Date (MM/DD/YYYY)
___ ___ / ___ ___ / ___ ___ ___ ___
Subscribed and sworn before me, this
Embosser or black ink rubber stamp seal
day of
year
State
County (or City of St. Louis)
My Commission Expires (MM/DD/YYYY)
__ __ /__ __ /__ __ __ __
Notary Public Signature
Notary Public Name (Typed or Printed)
*14305010001*
14305010001
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