Schedule Vc - Wisconsin Venture Capital Credits - 2012 Page 2
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22 of 2
2012 Schedule VC
Page
Part II
Early Stage Seed Investment Credit
7 Fill in the following information regarding your investments paid to a certified fund manager that the Wisconsin Economic Develop-
ment Corporation has verified as eligible for a tax credit in 2012 (attach separate schedules if more space is needed):
Date
Name and Address
Qualified
of Certified Fund
Total
Investment
Investment
Investment
Made
Manager
Total qualified investment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
Multiply line 7 by 25% (0.25) or enter the credit specially allocated to you . . . . . . . . . . . . . .
8
8
9
Fill in the 2012 early stage seed investment credit passed through from other entities . . . .
9
Add lines 8 and 9. This is your 2012 credit (see instructions). . . . . . . . . . . . . . . . . . . . . . . . 10
10
10a Fiduciaries - enter the amount of credit allocated to beneficiaries . . . . . . . . . . . . . . . . . . . . 10a
10b Fiduciaries - subtract line 10a from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10b
11
Carryover of unused early stage seed investment credit . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Add lines 10 and 11 (lines 10b and 11 if fiduciary). This is the available early stage seed
12
investment credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Part III
Transfer of Early Stage Seed Investment Credit
1 Fill in the following information regarding the transfer in 2012 by a person eligible to claim the early stage seed investment
credit to a person subject to tax under ch. 71 or subch. III or ch. 76:
Date of Approval
Transferred
Person Eligible
Recipient of Transferred Amount
Date of Consent
by Department
Amount
to Claim
of Early Stage Seed Investment
of Investment
Fund Manager
of Commerce or
the Early Stage Seed
Credit Subject to Tax Under ch. 71
the Wisconsin
Investment Credit
or subch. III of ch. 76
Economic
Development
(Name, Address, and Identifying Number)
(Name, Address, and Identifying Number)
Corporation
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