Form 527-A - Small Business Capital Company Report For Investors - 2011
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1
2
3State of Oklahoma
Small Business Capital Company
527-A
2
0
Report for Investors
1
The Small Business Capital Company must file Form 527 before this credit will be allowed.
1
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.
Social Security Number or
Federal Employer
Federal Employer
Identification Number ____________________________
Identification Number ______________________________
Name of Small Business Capital Company:
Name of Investor _________________________________
______________________________________________
Address _________________________________________
Address _______________________________________
City _______________________ State _____ Zip _______
City ____________________ State _____ Zip ________
Telephone Number ______________________________
See Tax Credit Moratorium on page 2.
Part 1:
Establishing the Small Business Capital Credit for Investors Filing on a Fiscal Year Basis
(4)
(1)
(2)
(3)
Date
Total Investment in,
Credit Allowable
of
or in conjunction with, the
Total Credit Available
in 2011 on investments
Investment
Small Business Capital Company
(Column 2 x 20%)
made on or after 1/1/2012
Total Credit Allowable in 2011
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 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:
2011 Credit Carryover
1.
Total credit allowable in 2011 ................................................................................ 1.
2.
Credits used in prior years:
Year
Amount
2011
(a)
$
(b)
2012
$
2013
(c)
$
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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