Tax Credit Form
DISTRICT OF COLUMBIA CERTIFIED INVESTOR TAX CREDIT TRANSFER AFFIDAVIT
(This form must be completed by the certified investor and each insurer to whom credits are transferred and must be filed with the Annual Notification of Credit Transfer (Form CPC 05−001).
Applies to Notification for Tax Year __________                                                • See instructions on back. (Page 2)
Address
Name of Contact Person
Name of Contact Person
Phone Number
Fax No.
E−mail Address
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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ORIGINAL
AMOUNT OF INVESTMENT
Once filed with the Annual Notification of Credit Transfer, this affidavit cannot be revoked for any reason.
Insurers receiving a transfer of CAPCO credits are limited to using their proportionate share of the CAPCO credits that the original certified investor would have been entitled to use during a tax year.
This form is due no later than 15 days following the sale or transfer of the tax credits.
For the Certified Investor:
For the Transferee:
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